[House Hearing, 117 Congress]
[From the U.S. Government Publishing Office]


     PUTTING KIDS FIRST: ADDRESSING COVID-19'S IMPACTS ON CHILDREN

=======================================================================

                             HYBRID HEARING

                               BEFORE THE

              SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS

                                 OF THE

                    COMMITTEE ON ENERGY AND COMMERCE
                        HOUSE OF REPRESENTATIVES

                    ONE HUNDRED SEVENTEENTH CONGRESS

                             FIRST SESSION
                               __________

                           SEPTEMBER 22, 2021
                               __________

                           Serial No. 117-48
                           
                           
                 [GRAPHIC NOT AVAILABLE IN TIFF FORMAT]                     


     Published for the use of the Committee on Energy and Commerce

                   govinfo.gov/committee/house-energy
                        energycommerce.house.gov
                        
                              __________

                    U.S. GOVERNMENT PUBLISHING OFFICE
                    
52-961 PDF                WASHINGTON : 2023                     
                        
                        
                        
                        
                    COMMITTEE ON ENERGY AND COMMERCE

                     FRANK PALLONE, Jr., New Jersey
                                 Chairman
BOBBY L. RUSH, Illinois              CATHY McMORRIS RODGERS, Washington
ANNA G. ESHOO, California              Ranking Member
DIANA DeGETTE, Colorado              FRED UPTON, Michigan
MIKE DOYLE, Pennsylvania             MICHAEL C. BURGESS, Texas
JAN SCHAKOWSKY, Illinois             STEVE SCALISE, Louisiana
G. K. BUTTERFIELD, North Carolina    ROBERT E. LATTA, Ohio
DORIS O. MATSUI, California          BRETT GUTHRIE, Kentucky
KATHY CASTOR, Florida                DAVID B. McKINLEY, West Virginia
JOHN P. SARBANES, Maryland           ADAM KINZINGER, Illinois
JERRY McNERNEY, California           H. MORGAN GRIFFITH, Virginia
PETER WELCH, Vermont                 GUS M. BILIRAKIS, Florida
PAUL TONKO, New York                 BILL JOHNSON, Ohio
YVETTE D. CLARKE, New York           BILLY LONG, Missouri
KURT SCHRADER, Oregon                LARRY BUCSHON, Indiana
TONY CARDENAS, California            MARKWAYNE MULLIN, Oklahoma
RAUL RUIZ, California                RICHARD HUDSON, North Carolina
SCOTT H. PETERS, California          TIM WALBERG, Michigan
DEBBIE DINGELL, Michigan             EARL L. ``BUDDY'' CARTER, Georgia
MARC A. VEASEY, Texas                JEFF DUNCAN, South Carolina
ANN M. KUSTER, New Hampshire         GARY J. PALMER, Alabama
ROBIN L. KELLY, Illinois, Vice       NEAL P. DUNN, Florida
    Chair                            JOHN R. CURTIS, Utah
NANETTE DIAZ BARRAGAN, California    DEBBBIE LESKO, Arizona
A. DONALD McEACHIN, Virginia         GREG PENCE, Indiana
LISA BLUNT ROCHESTER, Delaware       DAN CRENSHAW, Texas
DARREN SOTO, Florida                 JOHN JOYCE, Pennsylvania
TOM O'HALLERAN, Arizona              KELLY ARMSTRONG, North Dakota
KATHLEEN M. RICE, New York
ANGIE CRAIG, Minnesota
KIM SCHRIER, Washington
LORI TRAHAN, Massachusetts
LIZZIE FLETCHER, Texas
                                 ------                                

                           Professional Staff

                   TIFFANY GUARASCIO, Staff Director
                 WAVERLY GORDON, Deputy Staff Director
                  NATE HODSON, Minority Staff Director
              Subcommittee on Oversight and Investigations

                        DIANA DeGETTE, Colorado
                                  Chair
ANN M. KUSTER, New Hampshire         H. MORGAN GRIFFITH, Virginia
KATHLEEN M. RICE, New York             Ranking Member
JAN SCHAKOWSKY, Illinois             MICHAEL C. BURGESS, Texas
PAUL TONKO, New York                 DAVID B. McKINLEY, West Virginia
RAUL RUIZ, California                BILLY LONG, Missouri
SCOTT H. PETERS, California, Vice    NEAL P. DUNN, Florida
    Chair                            JOHN JOYCE, Pennsylvania
KIM SCHRIER, Washington              GARY J. PALMER, Alabama
LORI TRAHAN, Massachusetts           CATHY McMORRIS RODGERS, Washington 
TOM O'HALLERAN, Arizona                  (ex officio)
FRANK PALLONE, Jr., New Jersey (ex 
    officio)

                            C O N T E N T S

                              ----------                              
                                                                   Page
Hon. Diana DeGette, a Representative in Congress from the State 
  of Colorado, opening statement.................................     2
    Prepared statement...........................................     4
Hon. H. Morgan Griffith, a Representative in Congress from the 
  Commonwealth of Virginia, opening statement....................     5
    Prepared statement...........................................     6
Hon. Frank Pallone, Jr., a Representative in Congress from the 
  State of New Jersey, opening statement.........................     8
    Prepared statement...........................................     9
Hon. Cathy McMorris Rodgers, a Representative in Congress from 
  the State of Washington, opening statement.....................    10
    Prepared statement...........................................    12
Hon. Michael C. Burgess, a Representative in Congress from the 
  State of Texas, prepared statement.............................   119

                               Witnesses

Lee Beers, M.D., President, American Academy of Pediatrics.......    14
    Prepared statement...........................................    17
    Answers to submitted questions...............................   148
Margaret G. Rush, M.D., President, Monroe Carell Jr. Children's 
  Hospital at Vanderbilt.........................................    26
    Prepared statement...........................................    28
    Answers to submitted questions...............................   153
Arthur C. Evans, Jr., Ph.D., Chief Executive Officer, American 
  Psychological Association......................................    47
    Prepared statement...........................................    49
    Answers to submitted questions...............................   156
Kelly Danielpour, Founder, VaxTeen...............................    66
    Prepared statement...........................................    68
Tracy Beth Hoeg, M.D., Ph.D., Epidemiologist and Public Health 
  Expert, Private Practice Physician.............................    71
    Prepared statement...........................................    73

                           Submitted Material

Article of Sept. 14, 2021, ``Facebook Knows Instagram Is Toxic 
  for Teen Girls, Company Documents Show,'' by Georgia Wells, 
  Jeff Horwitz, and Deepa Seetharaman, Wall Street Journal, 
  submitted by Mr. Burgess.......................................   121

 
     PUTTING KIDS FIRST: ADDRESSING COVID-19'S IMPACTS ON CHILDREN

                              ----------                              


                     WEDNESDAY, SEPTEMBER 22, 2021

                  House of Representatives,
      Subcommittee on Oversight and Investigations,
                          Committee on Energy and Commerce,
                                                    Washington, DC.
    The subcommittee met, pursuant to call, at 10:30 a.m., in 
the John D. Dingell Room 2123, Rayburn House Office Building, 
and remotely via Cisco Webex online video conferencing, Hon. 
Diana DeGette (chair of the subcommittee) presiding.
    Members present: Representatives DeGette, Kuster, Rice, 
Schakowsky, Tonko, Ruiz, Peters, Schrier, Trahan, O'Halleran, 
Pallone (ex officio), Griffith (subcommittee ranking member), 
Burgess, McKinley, Palmer, Dunn, Joyce, and Rodgers (ex 
officio).
    Also present: Representatives McNerney, Bilirakis, and 
Carter.
    Staff present: Jesseca Boyer, Professional Staff Member; 
Austin Flack, Policy Analyst; Waverly Gordon, Deputy Staff 
Director and General Counsel; Tiffany Guarascio, Staff 
Director; Perry Hamilton, Clerk; Fabrizio Herrera, Staff 
Assistant; Zach Kahan, Deputy Director, Outreach and Member 
Service; Chris Knauer, Oversight Staff Director; Mackenzie 
Kuhl, Digital Assistant; Will McAuliffe, Counsel; Kaitlyn Peel, 
Digital Director; Chloe Rodriguez, Clerk; Andrew Souvall, 
Director of Communications, Outreach, and Member Services; C.J. 
Young, Deputy Communications Director; Sarah Burke, Minority 
Deputy Staff Director; Diane Cutler, Minority Detailee, 
Oversight and Investigations; Theresa Gambo, Minority Financial 
and Office Administrator; Marissa Gervasi, Minority Counsel, 
Oversight and Investigations; Brittany Havens, Minority 
Professional Staff Member, Oversight and Investigations; Nate 
Hodson, Minority Staff Director; Peter Kielty, Minority General 
Counsel; Emily King, Minority Member Services Director; Bijan 
Koohmaraie, Minority Chief Counsel, Oversight and 
Investigations Chief Counsel; Clare Paoletta, Minority Policy 
Analyst, Health; and Alan Slobodin, Minority Chief 
Investigative Counsel, Oversight and Investigations.
    Ms. DeGette. The Subcommittee on Oversight and 
Investigations hearing will now come to order.
    Today, the committee is holding a hearing entitled 
``Putting Kids First: Addressing COVID-19's Impact on 
Children.''
    Today's hearing will explore the impacts of the coronavirus 
disease of 2019 pandemic on children and adolescents in the 
United States.
    Due to the COVID-19 public health emergency, Members can 
participate in today's hearing either in person or remotely via 
online video conferencing.
    Members who are not vaccinated and participating in person 
must wear a mask and be socially distanced. Members may remove 
their mask when they are under recognition and speaking from a 
microphone.
    Staff and press who are not vaccinated and present in the 
committee room must wear a mask at all times and be socially 
distanced.
    For Members who are participating remotely, your 
microphones will be set on mute for the purpose of eliminating 
inadvertent background noise. Members participating remotely 
will need to unmute your microphone each time you wish to 
speak.
    Please note, once you unmute your microphone, anything that 
is said in Webex will be heard over the loudspeakers in the 
committee room and subject to be heard by the livestream and C-
SPAN, as everybody on this committee learned during our 
marathon markup last week.
    Because Members are participating from different locations 
at today's hearing, all recognition of Members, such as for 
questions, will be in the order of subcommittee seniority.
    If, at any time during the hearing, I'm unable to chair the 
hearing, the vice chair of the subcommittee, Mr. Peters--thank 
you for being here, Mr. Peters, I always appreciate it--will 
serve as chair until I'm able to return.
    Documents for the record can be sent to Austin Flack at the 
email address that we have provided to staff. All documents 
will be entered into the record at the conclusion of the 
hearing.
    And the Chair will now recognize herself for the purposes 
of an opening statement.

 OPENING STATEMENT OF HON. DIANA DeGETTE, A REPRESENTATIVE IN 
              CONGRESS FROM THE STATE OF COLORADO

    Today, the subcommittee continues to focus on its top 
priority for this year: aggressively exploring how to bring the 
COVID-19 pandemic to an end. To date, we've conducted extensive 
oversight and numerous hearings on critical issues relating to 
controlling the virus. From the on-ground experiences of State 
leaders to vaccine development, distribution, and uptake. 
Curbing COVID-19 has been and, unfortunately, still remains 
this subcommittee's top priority until we bring the pandemic to 
an end.
    Today's topic is central to the concerns of families across 
the country: how the pandemic affects our children and how to 
continue to ensure their health and well-being. As millions of 
students start the new school year, patients are facing 
agonizing decisions about in-person learning and childcare. 
Families across the country are balancing the risks and 
challenges of keeping their children safe, while striving to 
support their overall developmental and educational growth. 
Experts agree the best place for children is in the classroom--
but only if steps are taken to make schools a safe place.
    The goal we all share across this dais is keeping kids 
safe, a goal that has been threatened throughout the COVID-19 
pandemic. While children have been spared the same rates of 
severe symptoms or death as adults from the virus, we know that 
they are far from unscathed. Nearly 500 children have died due 
to COVID-19 in the United States, and another 5,000 children 
continue to suffer from a rare but serious inflammatory 
condition known as MIS-C.
    And although research is ongoing, we don't know the long-
term impacts COVID-19 infection has on children and 
adolescents, but, unfortunately, we do know that, just as among 
adults, Black and Hispanic youth face disproportionate impacts 
of COVID-19.
    We also know that vaccines remain the most effective tool 
to fight the virus. A vaccine is currently available for 
adolescents 12 and older, but, unfortunately, only less than 42 
percent of the younger teens are fully vaccinated.
    For kids under 12, we are all anxious for the FDA to 
authorize a safe and effective COVID-19 vaccine. Frankly, that 
approval cannot come soon enough. There's recent cause to be 
optimistic because the trial results for 5-to-11-year-old 
children released by Pfizer early this week appear to indicate 
that the vaccine is safe and effective for children.
    Pfizer will reportedly submit and request Emergency Use 
Authorization for this vaccine in just a week or two, with the 
request for children under 5 to follow in, later in this fall.
    We will be counting the days, but it's important to 
underscore that FDA's process to assure the safety of vaccine 
for our children is essential to building the trust of American 
families.
    In the meantime, ensuring people who are eligible get 
vaccinated is a vital step towards protecting children. Yet, 
while 65 percent of adults 18 and older are fully vaccinated 
across the country, that rate is still too low, and it dips 
further in some communities.
    I was in a community in western Colorado this weekend where 
only 46 percent of adults were vaccinated. That's just 
unacceptable, and it leads to the continuing spread of the 
Delta variant around the country.
    So while we wait for vaccines for younger children, there's 
other things we can do to help reduce the risk of COVID-19. For 
example, just as using car seats and seatbelts are easy ways to 
help protect our children while in a car, we know that simple 
acts like wearing masks and maintaining physical distance while 
outdoors can minimize risk to children. We need to encourage 
those practices as much as possible.
    However, contracting the virus isn't the only way our 
children's lives have been affected by the pandemic. Risks of 
exposure to COVID-19 last year led many parents to forego their 
children's visit to the doctor, leading to nearly 12 million 
fewer routine immunizations. And at the same time, other 
respiratory infections have surged or waned at atypical times, 
placing uncertainty and capacity challenges on children's 
hospitals.
    Also, the pandemic has had severe consequences on the 
mental health of America's youth. Even prior to the pandemic, 
adolescents in the U.S. experienced an epidemic of poor mental 
health, with increasing rates of stress, anxiety, depression, 
and suicidal thoughts and attempts.
    All of these things are things we need to work on, and so 
that's why today we're focusing on young people. I'm very happy 
that we have a young person to share her perspective today, 
because we all want what is best for our children. We want to 
keep our kids healthy and safe.
    United by that common purpose, we must work together to 
make sure we reduce the risk our children face and to do 
everything within our power to protect their health and well-
being.
    We all want an end to COVID-19 in our classrooms and in our 
communities, and I will work with the ranking member to make 
sure that's exactly what we do.
    [The prepared statement of Ms. DeGette follows:]

                Prepared Statement of Hon. Diana DeGette

    Today, the Subcommittee continues to focus on its top 
priority: aggressively exploring how to bring the COVID-19 
pandemic to an end.
    To date, we have conducted extensive oversight and numerous 
hearings on critical issues related to controlling the virus-
from on-the-ground experiences of state leaders, to vaccine 
development, distribution, and uptake.
    Curbing COVID-19 has been, and will remain, this 
Subcommittee's top priority until we bring this pandemic to an 
end.
    Today's topic is central to the concerns of families across 
the country: how the pandemic affects our children and how to 
ensure their health and wellbeing.
    As millions of students start the new school year, parents 
are facing agonizing decisions about in-person learning and 
childcare.
    Families across the country are balancing the risks and 
challenges of keeping their children safe while striving to 
support their overall developmental and educational growth.
    Experts agree that the best place for children is in the 
classroom--but only if steps are taken to make schools a safe 
place.
    The goal we all share across this dais is keeping kids 
safe--a goal that has been threatened throughout the COVID-19 
pandemic.
    While children have been spared the same rates of severe 
symptoms or death as adults from the virus, we know they are 
far from unscathed.
    Nearly 500 children have died due to COVID-19 in the United 
States and another 5,000 children continue to suffer from a 
rare but serious inflammatory condition known as MIS 09C.
    And, although research is ongoing, we do not yet know the 
long-term impacts of COVID-19 infection on children and 
adolescents.
    But we do know that--just as it is among adults--Black and 
Hispanic youth face disproportionate impacts of COVID-19.
    We also know that vaccines remain the most effective tool 
to fight the virus. A vaccine is currently available for 
adolescents 12 and older, yet fewer than 42 percent of these 
younger teens are fully vaccinated.
    For kids under 12, we are all anxious for FDA to authorize 
a safe and effective COVID-19 vaccine. That approval cannot 
come soon enough. Fortunately, there is recent cause to be 
optimistic. The trial results for five- to 11-year old children 
released by Pfizer earlier this week appear to indicate its 
vaccine is safe and effective for children.
    Pfizer will reportedly submit and request Emergency Use 
Authorization for the use of its vaccine in this age-group in 
just a couple weeks, with its request for children under five 
to follow in November.
    We will be counting the days, but it is important to 
underscore that FDA's process to assess the safety of the 
vaccine for our children is essential to building the trust of 
American families.
    In the meantime, ensuring that those who are eligible get 
vaccinated is a vital step toward protecting children. Yet, 
while 65 percent of adults 18 and older are fully vaccinated 
across the country, that rate is still too low and dips even 
lower in many communities.
    While we wait for vaccines for younger children, there are 
other concrete actions we can take to help reduce the risk of 
COVID-19 to kids.
    For example, just as using car seats and seat belts are 
easy ways to help protect our children while in a car, we know 
that simple acts, such as wearing masks and maintaining 
physical distance while indoors, can minimize risk to children. 
We need to encourage those practices as much as possible.
    However, contracting the virus isn't the only way our 
children's lives have been altered by this pandemic.
    Risks of exposure to COVID-19 last year led many parents to 
forgo their child's visit to the doctor, leading to nearly 12 
million fewer routine immunizations.
    At the same time, other respiratory infections have surged 
or waned at atypical times, placing additional uncertainty and 
capacity challenges on children's hospitals.
    The pandemic has also had severe consequences on the mental 
health and wellbeing of America's youth. Even prior to the 
pandemic, adolescents in the United States experienced an 
epidemic of poor mental health--with increasing rates of 
stress, anxiety, depression, and suicidal thoughts and 
attempts.
    As America's youth continue to face compounding stress from 
the pandemic, we must talk openly about children's mental 
health and the care they need--not just care when they are in 
crisis, but services to maintain their mental health.
    While Congress has taken numerous steps to address some of 
COVID-19's impacts and the resulting needs of children, today's 
witnesses can share their expertise and provide answers on what 
more Congress and the American people can do to help ease the 
challenges children continue to confront.
    To that end, I am pleased that as we focus on young people 
today, a young person is here to share her perspective.
    We all want what is best for our children: We all want to 
keep our kids healthy and safe.
    United by that common purpose, we must continue to work 
together to reduce the risks our children face and do 
everything within our power to protect their health and 
wellbeing.
    We all want an end to COVID-19 in our classrooms and in our 
communities. As Chair of this Subcommittee, I will continue to 
make ending the pandemic my top priority.

    Ms. DeGette. With that, I will yield 5 minutes to the 
ranking member for his opening statement.

OPENING STATEMENT OF HON. H. MORGAN GRIFFITH, A REPRESENTATIVE 
             IN CONGRESS FROM THE STATE OF VIRGINIA

    Mr. Griffith. Thank you very much. Appreciate it, Chairman 
DeGette, and I appreciate you holding this hearing.
    Overall, children are at a lower risk than adults for 
severe illness, hospitalization, and death due to COVID-19, but 
there is still a risk, particularly for those who are 
unvaccinated.
    After a decline of cases in children earlier this summer, 
cases in children have increased again and are currently making 
up 28.9 percent of reported COVID-19 cases.
    It is still unclear as to the definitive underlying reasons 
for this change. Some have hypothesized that these trends might 
be due to the Delta variant's high transmission rate. Others 
have suggested that it might be because many adults are now 
protected by vaccines and, therefore, adults are making up a 
smaller proportion of the reported infections and 
hospitalizations. Others think it might be because many 
children who largely stayed at home last year are now going 
outside of their homes more, creating increased exposure to the 
virus compared to what they experienced over the last year and 
a half.
    It is also likely that it is a combination of all of these 
factors, but it is important that we continue to study these 
trends to better understand the risk of COVID-19 in children.
    I understand that parents are worried about safety of their 
children and want to ensure that their kids are safe. I have 
school-aged children, and I share that concern. We owe it to 
our kids to keep them safe and to do so by following the 
science.
    In addition to keeping our children safe from getting 
infected with COVID-19, it is important to look at the impacts 
of COVID-19 on our children holistically, because it is not 
just the SARS-CoV-2 virus that can cause harm to our children. 
Many of our children are suffering from elevated levels of 
anxiety, depression, obesity, and eating disorders, or lagging 
in educational and social development resulting from the 
pandemic and school closures.
    There have also been concerns over increases in abuse and 
neglect of children during the COVID-19 pandemic and the 
impacts of many schools teaching remotely, since educators are 
mandatory reporters and serve as our primary reporters of the 
abuse and neglect of children in the United States.
    These concerns underscore the need for our children to 
remain in school for in-person learning. Thankfully, children 
can be back in school and be safe. The two are not mutually 
exclusive.
    I call on all States and local districts to focus on 
keeping schools open, prioritize our children, not political 
mantras.
    The Centers for Disease Control and Prevention, CDC, 
recommends that everyone 12 years of age and older get 
vaccinated.
    In addition, vaccine manufacturers continue to conduct 
clinical trials and collect data on vaccines for children 11 
years of age and younger. In fact, Pfizer and BioNTech recently 
announced that its COVID-19 vaccine is safe and appears to 
generate a robust immune response in a clinical trial of 
children 5 to 11 years old and plans to submit data to the U.S. 
Food and Drug Administration and other health regulators as 
soon as possible.
    Furthermore, Moderna expects to have data about its vaccine 
efficacy for children in the late fall or early winter.
    I encourage all parents and children to talk to their 
doctors about getting the COVID-19 vaccine.
    Another tool in our toolbox to keep children safe is 
accessible testing. Children experience symptoms that are 
consistent with COVID-19 symptoms for a variety of reasons. 
Thus, there needs to be a robust and regular testing strategy 
to prevent the spread of COVID-19 in schools, prevent schools 
from unnecessarily quarantining children and their families, 
and to avoid reverting back to exclusively remote learning.
    I look forward to today's discussion and learning more 
about how best to keep our children safe, not just from the 
virus itself but from the secondary harms of the virus.
    I thank our witnesses for being here today, and for those 
that are with us virtually, and for being a part of this 
important discussion.
    I yield back.
    [The prepared statement of Mr. Griffith follows:]

             Prepared Statement of Hon. H. Morgan Griffith

    Thank you, Chair DeGette, for holding this hearing.
    Overall, children are at lower risk than adults for severe 
illness, hospitalization, and death due to COVID-19, but there 
is still a risk, particularly for those who are unvaccinated. 
After a decline of cases in children earlier this summer, cases 
in children have increased again and currently make up 28.9 
percent of all reported COVID-19 cases.\1\
---------------------------------------------------------------------------
    \1\ Children and COVID-19: State-Level Data Report, American 
Academy of Pediatrics, available at https://www.aap.org/en/pages/2019-
novel-coronavirus-covid-19-infections/children-and-covid-19-state-
level-data-report/.
---------------------------------------------------------------------------
    It is still unclear as to the definitive underlying reasons 
for this change. Some have hypothesized that these trends might 
be due to the Delta variant's high transmission rate, others 
have suggested that it might be because many adults are now 
protected by vaccines and therefore adults are making up a 
smaller proportion of the reported infections and 
hospitalizations. Others think it might be because many 
children who largely stayed home last year are now going 
outside of their homes more, creating increased exposure to the 
virus compared to what they experienced over the last year and 
a half. It is also likely that it is a combination of all of 
these factors, but it is important that we continue to study 
these trends to better understand the risk of COVID-19 in 
children.
    I understand that parents are worried about the safety of 
their children and want to ensure that their kids are safe. I 
have children and share that concern. We owe it to our kids to 
keep them safe, and to do so by following the science.
    In addition to keeping our children safe from getting 
infected with COVID-19, it is also important to look at the 
impacts of COVID-19 on our children holistically because it is 
not just the SARS-CoV-2 virus that can cause harm to our 
children. Many of our children are suffering from elevated 
levels of anxiety, depression, obesity or eating disorders, and 
lagging educational and social development resulting from the 
pandemic and school closures.
    There have also been concerns over increases in abuse and 
neglect of children during the COVID-19 pandemic and the 
impacts of many schools teaching remotely, since educators are 
mandatory reporters and serve as our primary reporters in the 
U.S.\2\
---------------------------------------------------------------------------
    \2\ Elizabeth York Thomas, Ashri Anurudran, et al., Spotlight on 
child abuse and neglect response in the time of COVID-19, Elsevier 
Public Health Emergency Collection, Lancet Public Health (June 30, 
2020), available at https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC7326432/.
---------------------------------------------------------------------------
    These concerns underscore the need for our children remain 
in schools for in-person learning. Thankfully, children can be 
back in schools and be safe--the two are not mutually 
exclusive. I'd call on all States and local districts to focus 
on keeping schools open. Prioritize our children, not politics. 
Even President Biden recently agreed: ``if schools follow the 
science and implement safety measures children can be safe in 
schools, safe from COVID-19.''\3\ Let's make sure we are living 
up to that promise.
---------------------------------------------------------------------------
    \3\ Remarks by President Biden on How the Administration Is Helping 
to Keep Students Safe in Classrooms, Brookland Middle School, 
Washington, DC (Sept. 10, 2021), available at https://
www.whitehouse.gov/briefing-room/speeches-remarks/2021/09/10/remarks-
by-president-biden-on-how-the-administration-is-helping-to-keep-
students-safe-in-classrooms/.
---------------------------------------------------------------------------
    The Centers for Disease Control and Prevention (CDC) 
recommends that everyone 12 years of age and older get 
vaccinated. In addition, vaccine manufacturers continue to 
conduct clinical trials and collect data on vaccines for 
children 11 years of age and younger. In fact, Pfizer and 
BioNTech recently announced that its COVID-19 vaccine is safe 
and appears to generate a robust immune response in a clinical 
trial of children aged 5 to 11 years-old, and plans to submit 
the data to the U.S. Food and Drug Administration (FDA) and 
other health regulators as soon as possible.\4\ In addition, 
Pfizer-BioNTech expects to release clinical trial data for 
children aged 6-months to 5-years old as early as the end of 
October.\5\ Furthermore, Moderna expects to have data about its 
vaccine efficacy for young children in the late fall or early 
winter.\6\ I encourage all parents and children to talk to 
their doctors about getting the COVID-19 vaccine.
---------------------------------------------------------------------------
    \4\ Pfizer and BioNTech Announce Positive Topline Results from 
Pivotal Trial of COVID-19 Vaccine In Children 5 to 11 Years, Pfizer 
(Sept. 20, 2021), available at https://www.pfizer.com/news/press-
release/press-release-detail/pfizer-and-biontech-announce-positive-
topline-results; Berkeley Lovelace Jr., Pfizer says its Covid vaccine 
is safe and generates robust immune response in kids ages 5 to 11, CNBC 
(Sept. 20, 2021), available at https://www.cnbc.com/2021/09/20/pfizer-
covid-vaccine-is-safe-generates-robust-immune-response-in-kids-ages-5-
to-11.html.
    \5\ Berkeley Lovelace Jr., Pfizer CEO says Covid vaccine data for 
kids under age 5 may come in late October, CNBC (Sept. 14, 2021), 
available at https://www.cnbc.com/2021/09/14/pfizers-covid-vaccine-
data-for-kids-under-age-5-may-come-in-late-october-ceo-says-.html?utm--
source=newsletter&utm--medium=email&utm--campaign=newsletter--
axiosvitals&stream=top.
    \6\ Aria Bendix, Vaccines could get authorized young kids this 
fall. Here are the drug companies' most likely timelines, BUSINESS 
INSIDER (Aug. 31, 2021), available at https://www.businessinsider.com/
when-can-young-kids-get-vaccinated-timeline-2021-7.
---------------------------------------------------------------------------
    Another tool in our toolbox to keep children safe is 
accessible testing. Children experience symptoms that are 
consistent with COVID-19 symptoms for a variety of reasons. 
Thus, there needs to be a robust and regular testing strategy 
to prevent the spread of COVID-19 in schools, prevent schools 
from unnecessarily quarantining children and their families, 
and to avoid reverting back to remote learning.
    I look forward to today's discussion and learning more 
about how best to keep our children safe, not just from the 
virus itself, but from the secondary harms of the virus. I 
thank the witnesses for being here today and being part of this 
important discussion. I yield back.

    Ms. DeGette. I thank the gentleman.
    The Chair now recognizes the chairman of the full 
committee, Mr. Pallone, for 5 minutes for an opening statement.

OPENING STATEMENT OF HON. FRANK PALLONE, Jr., A REPRESENTATIVE 
            IN CONGRESS FROM THE STATE OF NEW JERSEY

    Mr. Pallone. Thank you, Chairwoman DeGette.
    The COVID-19 pandemic has been one of our Nation's most 
challenging periods. This committee has worked tirelessly to 
ensure that the Nation has the resources necessary to combat 
the pandemic. And I wanted to also thank Chair DeGette for her 
continued subcommittee's laser focus on efforts to end the 
pandemic.
    Helping Americans navigate safely through this public 
health crisis has been at the heart of these efforts, and today 
we continue that focus by examining the ways the pandemic is 
affecting our children.
    And as kids across the country head back to school, 
communities and families are now struggling with the Delta 
variant, a far more infectious version of the virus.
    Experts refer to the current wave of infections, and I 
quote, as ``a pandemic of the unvaccinated''--and yet, while 
safe and effective vaccines are available to American adults 
and adolescents, children under the age of 12 are not yet 
eligible for these vaccines.
    As the more contagious Delta variant continues to spread, 
the number of children with COVID-19 continues to climb. 
Pediatric units around the Nation, but particularly in States 
with low vaccination rates, are seeing a surge in 
hospitalizations. And this is understandably concerning to 
parents who just want to keep their children safe.
    Now, it's on all of us to do everything that we can to keep 
these kids safe. We all have a part to play in getting 
vaccinated, practicing safety precautions, and looking out for 
one another. Critically, it's important that government leaders 
follow the science so that we keep our children safe. And State 
and local actions that ignore or even contradict the science 
put our children at risk and undermine our ability to end the 
pandemic.
    It's also important to understand that children are 
experiencing this pandemic differently than adults. Difficult 
choices are often made for them by parents, caregivers, and 
teachers. And more than ever before, children and their 
families are being forced to balance numerous complicated 
risks.
    The mental health of our children, in particular, is of 
grave concern. There were already challenges in addressing the 
mental health needs of children before the pandemic. But those 
have been exacerbated by increased social isolation, missed 
milestones such as graduations, and sick or lost family 
members, friends, or caregivers. So we have to continue to find 
ways to address the mental health needs of our kids so that 
they not only survive through the pandemic but thrive once it's 
over.
    So this committee, Congress, and the Biden administration 
have taken important steps in providing schools, healthcare 
institutions, and families with much-needed resources. Earlier 
this year, Congress passed the American Rescue Plan, which 
provided funding for the safe operation of schools and 
expansion of pediatric mental healthcare. And just last week, 
this committee passed the Build Back Better Act, which among 
other critical public health provisions includes a permanent 
extension of the Children's Health Insurance Program, or CHIP, 
and investments in children's mental health programs.
    The Biden administration has taken bold action to support 
the safe reopening of schools. This includes significant 
efforts to increase the vaccination rate of adults and children 
over 12, which can build a blanket of protection for the 
children around them.
    I'm also encouraged by reports that at least one vaccine 
manufacturer may be submitting an application for a COVID-19 
vaccine for children very soon, and the FDA has said it intends 
to act on that application when it comes within a matter of 
weeks.
    And the Centers for Disease Control and Prevention has 
issued critical guidance throughout the pandemic, including 
guidance for healthcare providers, community and business 
leaders, and recent guidance for educators and school 
administrators. So it will continue to take all of us working 
together to keep our children safe.
    I thank our witnesses for joining us today to share their 
expertise and perspectives on what more we can do to protect 
America's children. And together we have to navigate the 
challenges of providing for safety of the Nation's children and 
do everything in our power to ensure health and promising 
futures.
    I just want to thank Chair DeGette again for another 
important hearing with your O&I Subcommittee. I do think this 
is really important. Thank you, Diana.
    I yield back.
    [The prepared statement of Mr. Pallone follows:]

             Prepared Statement of Hon. Frank Pallone, Jr.

    The COVID-19 pandemic has been one of our nation's most 
challenging periods. This Committee has worked tirelessly to 
ensure that the nation has the resources necessary to combat 
the pandemic, and I want to thank Chair DeGette for her 
Subcommittee's continued laser focus on efforts to end the 
pandemic.
    Helping Americans navigate safely through this public 
health crisis has been at the heart of these efforts and today, 
we continue that focus by examining the ways the pandemic is 
affecting our children.
    As kids across the country head back to school, communities 
and families are now struggling with the Delta variant, a far 
more infectious version of the virus.
    Experts refer to the current wave of infections as a 
``pandemic of the unvaccinated.'' And yet, while safe and 
effective vaccines are available to American adults and 
adolescents, children under the age of 12 are not yet eligible 
for those vaccines. As the more contagious Delta variant 
continues to spread, the number of children with COVID-19 
continues to climb. Pediatric units around the nation, but 
particularly in states with low vaccination rates, are seeing a 
surge in hospitalizations. This is understandably concerning to 
parents who just want to keep their children safe.
    It is on all of us to do everything that we can to keep 
them safe. We all have a part to play in getting vaccinated, 
practicing safety precautions, and looking out for one another. 
Critically, it is important that government leaders follow the 
science so that we keep our children safe. State and local 
actions that ignore or even contradict the science put our 
children at risk and undermine our ability to end this 
pandemic.
    It is also important to understand that children are 
experiencing this pandemic differently than adults. Difficult 
choices are often made for them by parents, caregivers, and 
teachers. And, more than ever before, children and their 
families are being forced to balance numerous, complicated 
risks.
    The mental health of our children, in particular, is of 
great concern. There were already challenges in addressing the 
mental health needs of children before the pandemic. Those 
challenges have been exacerbated by increased social isolation; 
missed milestones such as graduations; and sick or lost family 
members, friends, or caregivers. We must continue to find ways 
to address the mental health needs of our children so that they 
not only survive through the pandemic but thrive once it is 
over.
    This Committee, Congress, and the Biden administration have 
taken important steps in providing schools, health care 
institutions, and families with much-needed resources.
    Earlier this year, Congress passed the American Rescue 
Plan, which provided funding for the safe operation of schools 
and expansion of pediatric mental health care. And just last 
week, this Committee passed the Build Back Better Act, which 
among other critical public health provisions, includes a 
permanent extension of the Children's Health Insurance Program 
and investments in children's mental health programs.
    The Biden administration has taken bold action to support 
the safe reopening of schools. This includes significant 
efforts to increase the vaccination rate of adults and children 
over 12, which can build a blanket of protection for the 
children around them. I am also encouraged by reports that at 
least one vaccine manufacturer may be submitting an application 
for a COVID-19 vaccine for children very soon. The Food and 
Drug Administration has said it intends to act on that 
application when it comes within a matter of weeks.
    And the Centers for Disease Control and Prevention has 
issued critical guidance throughout the pandemic, including 
guidance for health care providers, community and business 
leaders, and recent guidance for educators and school 
administrators.
    It will continue to take all of us working together to keep 
our children safe. I thank our witnesses for joining us today 
to share their expertise and perspectives on what more we can 
do to protect America's children as we strive to end the 
pandemic. Together, we must navigate the challenges of 
providing for the safety of the nation's children and do 
everything in our power to ensure healthy and promising 
futures.

    Ms. DeGette. I thank the chairman.
    The Chair now recognizes the ranking member of the full 
committee, Mrs. Rodgers, for 5 minutes for purposes of an 
opening statement.

      OPENING STATEMENT OF HON. CATHY McMORRIS RODGERS, A 
    REPRESENTATIVE IN CONGRESS FROM THE STATE OF WASHINGTON

    Mrs. Rodgers. Thank you, Madam Chair.
    This pandemic has taken a toll on all of us. It's been a 
challenging time for everyone, especially for those who've lost 
loved ones. Let me be clear: My heart breaks for any parent 
who's had to bury their child.
    One death from COVID is too many, but we need to recognize 
what our response is doing to kids. CNN and MSNBC will have you 
believe that the greatest threat to America's children is 
COVID-19. They're wrong. And the fear mongering is making it 
impossible for parents to assess risk and make the best 
decisions for their kids.
    The truth? If infected with COVID-19, children ages 0 to 9 
have about a 0.1 percent chance of being hospitalized. Ages 11 
to 19 is about 0.2 percent.
    Recent data from the Public Health of England found that 
COVID-19 poses a lower risk of hospitalization to unvaccinated 
children than it does to fully vaccinated 40-to-49-year-olds.
    According to the American Academy of Pediatricians, 0.00 
percent to 0.03 percent of all reported child COVID-19 cases 
have resulted in deaths.
    I know the Delta variant is scary. It's more infectious. 
But from what we've seen so far, it is not more severe. Rather 
than accept this reality, too many of our leaders and people 
like President Biden want us to continue to live in fear.
    Because of that fear, too many continue to push policies 
focused only on COVID-19 and cruel restrictions--restrictions 
that they don't even want to follow themselves. This is all 
eroding trust, eroding trust in public health.
    Where is the consideration of other aspects of health and 
children's overall well-being and mental health? Our children 
are in crisis. Emergency room visits for mental health for 
children ages 5 to 11 and 12 to 17 increased by 24 percent and 
31 percent since the start of this pandemic. Visits for 
suicidal ideation, attempts, and self-harm among children rose 
by more than 2.5 times.
    What about their education and future? One study found that 
each month of school closures cost students between 12,000 and 
15,000 in future earnings.
    In Maryland, 41 percent of all Baltimore City high school 
students earned below a 1.0 GPA in 2020.
    What about their social, emotional, and physical 
development? Mask-wearing and social isolation is taking a 
toll. Shutdowns and isolation contributed to children and teens 
gaining weight at an alarming rate.
    This was a COVID-19 policy that actually made children more 
unhealthy and more at risk to COVID-19. How is that following 
the science?
    Our kids are in crisis, and, unfortunately, this 
administration is more focused on political allies than 
science.
    What happened to leading with science? President Biden's 
administration is guilty of what Democrats claimed of the Trump 
administration: prioritizing politics over science.
    In May, CDC was exposed for working with some of Biden's 
biggest campaign donors, powerful teachers unions, to draft 
what was supposed to be the scientific guidance for schools. 
Thanks to the teachers unions' influence, the guidance put out 
by CDC likely led to more school closures. Six-feet social 
distancing was a major roadblock to keeping schools open.
    And, although CDC Director Walensky recommended 3 feet to 
her hometown prior to running for CDC, when she became 
Director, she kept it at 6 feet. Ask yourself why.
    Recently, we saw Biden's CDC ignore science and again cave 
to the teachers union. On May 13th, the CDC announced that 
fully vaccinated Americans could stop wearing masks indoors. It 
upset the teachers union.
    After receiving private threats about public statements 
criticizing the administration, the CDC promptly issued an 
update. Now, all people in schools should wear masks regardless 
of vaccination status.
    It's even more concerning when you realize that the U.S. is 
an outlier for COVID-19 policies for kids. Our CDC recommends 
masking kids 2 and older, but international partners do not. 
The European CDC recommends masking adults, not kids, in 
primary schools.
    The World Health Organization and UNICEF specifically 
recommend against masking kids under age 5 and under. For kids 
6 to 11, they actually consider other factors when making 
decisions about masks--the impact on learning and social 
development. So why don't we? I would submit today that we 
should. We must put our kids first.
    I yield back.
    [The prepared statement of Mrs. Rodgers follows:]

           Prepared Statement of Hon. Cathy McMorris Rodgers

COVID RISK
    This pandemic has taken a toll on all of us. It has been a 
challenging time for everyone, particularly for those who have 
lost loved ones.
    Let me be clear: no parent should have to bury their child. 
One death from COVID-19 is too many.
    But we need to have an honest conversation about what our 
response is doing to kids.
    CNN and MSNBC will have you believe the greatest threat to 
America's children is COVID-19.
    They are wrong ...
    ... and their fear mongering is making it harder for 
parents to assess risks and make the best decisions for their 
children.
    The truth?
     If infected with COVID-19, children ages 0 to 9 
have about a 0.1 percent chance of being hospitalized. for ages 
11 to 19, it is about 0.2 percent.
     Recent data from Public Health of England found 
that COVID-19 poses a lower risk of hospitalization to 
unvaccinated children than it does to fully vaccinated 40 to 
49-year-olds.
     According to the American Academy of Pediatrics, 
0.00 percent to 0.03 percent of all reported child COVID-19 
cases have resulted in deaths.
    I know the Delta variant is scary.
    It is more infectious--but from what we have seen so far, 
it is not more severe.
    Rather than accept this reality too many elites and people 
like President Biden want us to continue to live in fear for 
more control.
    And because of that fear, too many elected officials 
continue to push policies focused ONLY on COVID-19 and cruel 
restrictions--restrictions that they themselves don't want to 
follow.
    They are eroding trust in public health.
    Where is the consideration of other aspects of health and 
children's overall well-being and mental health?
OTHER FACTORS
    Emergency room visits for mental health for children ages 5 
0911 and 12 0917 increased by 24 percent and 31 percent since 
the start of the pandemic.
    Visits for suicidal ideation, attempts, and self-harm among 
children rose by more than 2.5 times.
    What about their education and future?
    One study found that each month of school closures cost 
students between $12,000 and $15,000 in future earnings.
    In Maryland, 41 percent of all Baltimore City high school 
students earned below a 1.0 GPA in 2020.
    What about their social, emotional, and physical 
development?
    Mask-wearing and social isolation are taking a toll.
    Shutdowns and isolation contributed to children and teens 
gaining weight at an alarming rate.
    This was a COVID-19 policy that actually made children more 
unhealthy and more at risk to COVID-19. How is this following 
the science?
    Our kids are in crisis, and unfortunately, this 
Administration is more focused on political favors, than 
science.
SCHOOL POLICIES
    President Biden promised he would lead with science and 
truth.
    But his administration is guilty of what Democrats claimed 
of the Trump Administration: prioritizing politics over 
science.
    In May, the CDC was exposed for working with some of 
Biden's biggest campaign donors--powerful teachers' unions--to 
draft what is supposed to be scientific guidance for schools.
    Thanks to the teachers' unions influence, the guidance put 
out by the CDC likely led to MORE school closures.
    6 feet of social distancing was a major roadblock to 
keeping schools open--and although CDC Director Walensky 
recommended 3 feet to her hometown prior to running the CDC, 
when she became Director, she kept it at 6 feet.
    Ask yourself why.
    Recently, we saw Biden's CDC ignore science and AGAIN cave 
to teachers' unions.
    On May 13, the CDC announced that fully vaccinated 
Americans could stop wearing masks indoors--which upset the 
teachers unions.
    After receiving private threats about public statements 
criticizing the Administration, the CDC promptly issued an 
update--now all people in schools should wear masks regardless 
of vaccination status.
U.S. v. EUROPE
    It is even more frustrating when you realize the U.S. is an 
outlier for COVID-19 policies for kids.
    Our CDC recommends masking kids 2 years and older, but our 
international partners do not.
    The European CDC recommends masking adults, but not kids in 
primary schools.
    The World Health Organization and UNICEF specifically 
recommend against masking children aged 5 and under.
    For children ages 6 0911, the WHO and UNICEF actually 
consider other factors when making decisions about masks--among 
them, the impact of on learning and social development.
    Why don't we?
    It is time the U.S. consider the safety and overall well-
being of our children.
    Let's put our kids first.
    Thank you. I yield back.

    Ms. DeGette. The Chair now asks unanimous consent that all 
Members' written opening statements be made part of the record.
    And, without objection, they will be entered in.
    I now want to introduce the witnesses for today's hearing.
    Dr. Lee Savio Beers, the president of the American Academy 
of Pediatrics; Dr. Margaret Rush, president, Monroe Carell Jr. 
Children's Hospital at Vanderbilt--welcome; Dr. Arthur Evans, 
the chief executive officer at the American Psychological 
Association; Kelly Danielpour, who will be appearing virtually, 
who is the founder of VaxTeen. And if you haven't read Kelly's 
resume, it's incredibly impressive the work that Kelly has 
done. And Dr. Tracy Beth Hoeg, who's an epidemiologist and 
public health expert and private practice physician.
    With that, welcome everybody. We're excited to hear what 
you say from a scientific and personal perspective.
    And I am sure you all know that this committee takes its 
testimony under oath because we're having an investigative 
hearing.
    Does anybody have any objection to testifying under oath?
    Let the record reflect that the witnesses responded no.
    The Chair then advises everyone that, under the rules of 
the House and the rules of the committee, you are entitled to 
be accompanied by counsel.
    Does anyone here wish to be accompanied by counsel?
    Let the record reflect that the witnesses nodded no.
    So if you would, please rise and raise your right hand so 
you may be sworn in.
    [Witnesses sworn.]
    Ms. DeGette. You may be seated.
    And let the record reflect that all the witnesses responded 
affirmatively.
    And you're now under oath and subject to the penalties set 
forth in title 18, section 1001, of the United States Code.
    Now, at this point, the Chair will recognize each witness 
for 5 minutes to provide their opening statement. So before I 
begin, I want to explain the lighting system for the people who 
are testifying in person.
    In front of you is a series of lights. The light will 
initially be green. The light turns yellow when you have 1 
minute remaining, and so please begin to wrap up your 
testimony. The light will turn red when your time expires. And 
I will let you finish your sentence, don't worry.
    For witnesses testifying remotely, you will see a timer on 
your screen that will count down your remaining time.
    And so now, Dr. Beers, I am very pleased to recognize you 
for 5 minutes.

 STATEMENTS OF LEE BEERS, M.D., PRESIDENT, AMERICAN ACADEMY OF 
 PEDIATRICSM; MARGARET G. RUSH, M.D., PRESIDENT, MONROE CARELL 
 Jr. CHILDREN'S HOSPITAL AT VANDERBILT; ARTHUR C. EVANS, Jr., 
    Ph.D., CHIEF EXECUTIVE OFFICER, AMERICAN PSYCHOLOGICAL 
  ASSOCIATION (APA); KELLY DANIELPOUR, FOUNDER, VAXTEEN; AND 
TRACY BETH HOEG, M.D., Ph.D., EPIDEMIOLOGIST AND PUBLIC HEALTH 
               EXPERT, PRIVATE PRACTICE PHYSICIAN

                  STATEMENT OF LEE BEERS, M.D.

    Dr. Beers. Thank you so much, Chairwoman DeGette, Ranking 
Member Griffith, Chairman Pallone, and Ranking Member McMorris 
Rodgers, and members of the committee. Thank you so much for 
the opportunity to speak with you today.
    I'm Lee Beers, a pediatrician and president of the American 
Academy of Pediatrics, or AAP, which represents over 67,000 
pediatricians across the country.
    I agree the past 18 months have been extremely challenging 
for America's children, and pediatricians have seen firsthand 
the impact of COVID on children, both directly and indirectly.
    While COVID-19 infection is generally not as severe in 
children as adults, lower risk does not mean no risk, and many 
children have become very sick from COVID-19.
    According to information compiled by AAP and the Children's 
Hospital Association, to date more than 5.5 million children 
have been infected by the virus since the start of the 
pandemic, over 21,000 children have been hospitalized, and 480 
children have died as a result of COVID-19.
    Even more tragically, in many cases these hospitalizations 
and deaths could have been prevented through safe and simple 
measures. More than two-thirds of these deaths have been in 
Black and Latinx children, which shows the disproportionate 
effects of the virus on children of color.
    While studies have shown that the Delta variant may not 
cause more severe cases of COVID-19, it is indeed more 
transmissible. In recent weeks, we've seen about a quarter 
million new cases reported in children each week, reaching 
levels even higher than we saw during the spike last winter.
    And, fortunately, we know what to do to reverse this 
concerning trend. Vaccines are the key to dramatically 
decreasing the spread of the virus and allowing children to 
return fully to doing all the things they love to do and that 
help them thrive.
    Thankfully, a safe and effective COVID vaccine has been 
available for adolescents 12 and older since May. But, 
unfortunately, vaccination for adolescents lags behind adults. 
Only 54 percent of 12-to-17-year-olds have yet been vaccinated, 
compared to over 76 percent of adults.
    And while we have more work to do to increase vaccination 
among older children, we are hopeful that a vaccine for 
children ages 5 to 11 will also be authorized soon.
    We believe the FDA has the right regulatory approach in 
place so that when it authorizes a vaccine for younger 
children, we can be highly confident that it's safe and 
effective.
    We also cannot forget that we have work to do to ensure 
children receive their routine vaccinations that protect them 
against serious preventable diseases, such as measles, 
hepatitis, and rotavirus. Children have missed millions of 
doses since the start of the pandemic because many missed their 
checkups.
    And one of the primary barriers to improved vaccination 
rates overall is vaccine hesitancy. Many parents have fairly 
typical concerns about the potential side effects of vaccines, 
and these concerns can usually be addressed through education 
from trusted community members like pediatricians.
    But the level of misinformation and disinformation about 
COVID vaccines that's been circulating online has been 
astounding, and this has proven much more difficult to address.
    Sadly, many pediatricians have also been personally 
targeted with attacks as a result of this misinformation. 
Pediatricians I've personally spoken to and their staff have 
been harassed, booed, spit upon, and threatened. Some have had 
to implement increased security in their home and work.
    Needing to defend and protect oneself against these 
baseless personal attacks distracts and diverts resources from 
our ability to provide care for children and families.
    I urge us all to come together in a coordinated national 
effort to fight misinformation, reestablish our trust in 
science, and support those on the front lines working to end 
this pandemic.
    At this point, the COVID-19 pandemic has disrupted 3 
separate school years for children across this country, with 
wide-ranging impacts not only on children's educational 
attainment but also their social, emotional, behavioral, and 
physical health.
    Because of the invaluable role that schools and in-person 
learning play in a child's development and well-being, the AAP 
has strongly advocated that we do everything we can to keep 
children safe so they can attend school in person. To do this, 
it's imperative for schools to employ multilayered protective 
measures to keep the school community safe until vaccination 
rates are high enough to significantly reduce the spread of 
COVID-19.
    At this time, pediatricians recommend universal masking in 
school for all students older than 2 years and all school 
staff, unless medical or developmental conditions prohibit use, 
as well as a number of other straightforward, simple, and 
layered measures.
    I want to end today by addressing the mental health 
challenges of children and families. Emotional and behavioral 
health needs in children and adolescents were a growing concern 
well before the COVID-19 pandemic, but the pandemic has acutely 
exacerbated these challenges to near crisis levels.
    Now more than ever, families and children from infancy 
through adolescence need access to mental health screenings, 
diagnostics, and the full array of evidence-based therapeutic 
services to appropriately address their needs.
    But there are many barriers to these services in the 
community. My written testimony identifies a number of these 
opportunities for Congress to address these barriers, and I'm 
happy to answer questions.
    We look forward to working with the committee on this 
critical issue. Thank you so much for inviting me to testify 
today, and I look forward to your questions later.
    [The prepared statement of Dr. Beers follows:]

[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
    
    Ms. DeGette. Thank you so much, Dr. Beers.
    Dr. Rush, now I'm pleased to recognize you for 5 minutes 
for an opening statement.
    You need to push your button there.

              STATEMENT OF MARGARET G. RUSH, M.D.

    Dr. Rush. Chairwoman DeGette, Ranking Member Griffith, and 
distinguished members of the subcommittee, thank you for the 
opportunity to testify today. My name is Dr. Meg Rush, and I 
serve as president of Monroe Carell Jr. Children's Hospital at 
Vanderbilt on the Vanderbilt University Medical Center campus 
in Nashville, Tennessee.
    I'm truly honored to be here to share the perspectives of 
children's hospitals as we have navigated the pandemic and 
appreciate the opportunity to speak more broadly about the 
pandemic's impact on child health and well-being.
    Although COVID-19 is much less likely to lead to death in 
children, many children are contracting the Delta variant and 
becoming sick.
    Tennessee is one of several southern States where there is 
some degree of vaccine unreadiness. Our lower rates of 
vaccination are clearly correlated with the fact that Tennessee 
is intermittently ranked number one for the highest number of 
COVID-positive cases in both adults and children as recently as 
Monday of this week, which, in turn, has resulted in high 
numbers of hospitalizations.
    I want to begin by telling you about Sophia. As she and her 
parents prepared for the start of kindergarten, neither parent 
was vaccinated. Within a few days of starting school, Sophia 
contracted COVID-19 and developed mild symptoms. Unfortunately, 
both parents became infected and, tragically, neither survived. 
Sophia, now orphaned, joins 1.5 million children worldwide who 
has lost a caregiver. She will carry this pain forever.
    Children's hospitals account for 2 percent of the hospitals 
across the United States, yet we are the safety net for all 
pediatric healthcare for 20 percent of the Nation's population.
    Children's hospitals have experienced the opposite ends of 
the spectrum over the past 18 months. In 2020, children's 
hospitals [inaudible] for uncertainty of how COVID-19 would 
impact children. It turns out that biological differences 
combined with putting health measures in place not only 
resulted in comparatively few cases of COVID-19 infection in 
children but also near disappearance of many other respiratory 
illnesses of childhood that often result in hospitalization.
    Utilization of healthcare by children decreased 
dramatically, resulting in large volume and revenue shortfalls 
by both children's hospitals and pediatricians. This revenue 
shortfall caused staffing downsizing in some children's 
hospitals. Others such as mine stepped up to help adjacent 
adult hospitals either by sharing staff, offering beds, or 
both.
    Entering 2021, modeling suggested that children's hospitals 
could experience ongoing volume and revenue shortfalls if 
children continued to be so healthy. But 6 months ago, we saw 
an unprecedented off-season spike of the typical fall and 
winter viral infections. Volumes increased dramatically, with 
many children becoming critically ill, and in the summer COVID-
19 Delta surge began, further compounding ongoing capacity and 
staffing challenges.
    Although children were much less sick last year, their 
health and well-being was negatively impacted. As we know, 
children and families across the country faced substantial 
disruptions to their daily lives due to COVID-19.
    The Vanderbilt Child Health Poll conducted in 2020 presents 
a snapshot of factors that, taken together, negatively impact 
the health of children, particularly those who face other 
socioeconomic disadvantages. Changes in insurance, economic 
instability, increased food insecurity, decreased physical 
activity, learning, and socialization are all significant 
factors that impact child health.
    Fear of the pandemic also caused some families to delay 
healthcare for their children even if they were sick. And I 
would be remiss if I did not mention the parallel behavioral 
health epidemic that was well underway before the onset of the 
pandemic but clearly worse now.
    Multifactorial in nature, youth from ages 4 to 18 present 
to children's hospitals in crisis. As acute care hospitals, our 
options are to hold these patients in our emergency departments 
or admit them to acute care beds until there is an appropriate 
safety care plan.
    Yesterday, I had 34 children admitted for behavioral health 
crisis in my hospital. Twenty-four of these were medically 
cleared but needed an executable care plan for their mental 
health.
    Throughout the pandemic, Congress has provided billions in 
funding to support clinical care, public health activities, and 
research and therapies and vaccine development.
    As my testimony outlines, there remain opportunities, 
particularly in the space of health and well-being of children, 
including legislation put forward by members of the Energy and 
Commerce Committee.
    Thank you in advance for your consideration of supporting 
the youth in our Nation. Sophia and all like her are truly our 
future. Thank you.
    [The prepared statement of Dr. Rush follows:]

[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
    
    Ms. DeGette. Thank you so much, Dr. Rush.
    Dr. Evans, I'm now pleased to recognize you for 5 minutes 
for an opening statement.

            STATEMENT OF ARTHUR C. EVANS, Jr., Ph.D.

    Dr. Evans. Chair DeGette, Chairman Pallone, Ranking Member 
Griffith, Ranking Member McMorris Rodgers, and members of the 
subcommittee, thank you for this opportunity to testify today. 
I'm Dr. Arthur C. Evans, CEO of the American Psychological 
Association.
    The APA is the largest scientific and professional 
organization representing psychology in the U.S., with over 
122,000 clinicians, researchers, consultants, and students as 
its members and affiliates. APA appreciates the subcommittee's 
focus on the mental health of the Nation's youth.
    Children and adolescents have been especially affected by 
the COVID-19 pandemic, experiencing higher rates of stress, 
anxiety, and fear. Social isolation, financial uncertainty, and 
disrupted routines place considerable stress on children and 
their families. And we remain especially concerned about 
increases in the rates of suicide attempts and other forms of 
self-harm among children and youth, particularly among those 
within communities of color.
    The reason for these phenomena are manifold, and many of 
these concerns were already present prior to the pandemic.
    Psychological research tells us that the mental health of 
children is frequently tied to the health of their 
surroundings, such as their communities, schools, and homes. 
And if traumatic events are occurring in these settings, they 
almost always have a downstream impact on children's well-
being.
    Psychological science also shows that the consequences of 
untreated mental health needs on the overall trajectory of 
children's lives. This can include a greater likelihood of 
difficulties with learning, addiction to substances, learning, 
lower employment prospects, and involvement with the criminal 
justice system.
    This concern is amplified for individuals from underserved 
communities and communities of color who have long struggled 
with the social determinants that lead to behavioral health 
conditions and inadequate access to behavioral health services.
    There is no one-size-fits-all solution to meeting all of 
the mental health needs among children, but the science is 
clear in several areas.
    One key area is early detection and intervention. As 
children return to school, comprehensive, school-based mental 
health services, such as those provided by school 
psychologists, are critical to overcoming learning loss and 
addressing behavioral health issues effectively.
    We must also invest in opportunities to foster positive 
school climates. This includes integrating evidence-based and 
culturally competent social and emotional learning programs, 
and promoting trauma-informed approaches to teaching and 
student well-being.
    Outside of schools, we must ensure that children and 
families have access to high-quality mental health services, 
including telehealth. We need to invest in more behavioral 
health research to support early intervention. We also need to 
equip educators, families, and communities to recognize early 
signs of mental health and emotional distress in children.
    While APA appreciates Congress' significant investments in 
mental health during the COVID-19 pandemic, part of the problem 
is that such funding is temporary, which often inhibits the 
ability of States and school systems to make long-term 
investments in their mental health workforce and 
infrastructure.
    New investments must be made with the understanding that a 
long-term commitment is needed. We must avoid perpetuating a 
false choice between children's education and mental well-being 
and their physical health and safety. We need both.
    Ideally, all children should be in a physical classroom 
with their teachers and peers. We can and should be doing 
everything possible to reopen schools safely, adhering to 
proven public health measures while providing virtual options 
if they become necessary.
    Federal, State, and local governments should be working in 
concert to ensure that all children continue to have access to 
equitable education and support services, while staying 
mentally and physically healthy.
    I applaud the subcommittee for convening today's hearing. 
The challenges we currently face provide us with an 
extraordinary opportunity to reimagine how we address the 
behavioral health of all of our citizens, including our 
youngest.
    Thank you, and I look forward to answering your questions.
    [The prepared statement of Dr. Evans follows:]

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    Ms. DeGette. Thank you so much, Dr. Evans.
    I'm now very pleased to recognize Ms. Danielpour for 5 
minutes.

                 STATEMENT OF KELLY DANIELPOUR

    Ms. Danielpour. Good morning, Chair DeGette, Ranking Member 
Griffith, and members of the subcommittee. Thank you for the 
opportunity to speak--to share my perspective on the COVID-19 
pandemic's impact on young people, and for recognizing the 
importance of this topic.
    My name is Kelly Danielpour, and I'm the founder of 
VaxTeen, as well as a first-year undergraduate student at 
Stanford University.
    In April 2019, at the age of 16, I came across a post on 
Reddit that stunned me. The author was the same age as me but 
was facing a situation I'd never had to consider. His parents 
refused to allow him to be vaccinated. He tried to reason with 
them but to no avail.
    And he was concerned. Yes, he feared the danger that 
vaccine-preventable diseases posed to his own health, but 
primarily he was worried about the danger that he posed to 
those around him by being unvaccinated.
    I was struck by his dilemma and by his profound 
consideration for others. It sent me down a rabbit hole of 
research, where I discovered that many of my peers had similar 
queries about vaccination, yet there was a lack of clear 
answers.
    I was inspired to create VaxTeen, an organization that 
communicates directly with teenagers and young adults to 
counter the growing antivaccine movement. We work to educate 
young [inaudible] their own health.
    VaxTeen encourages those who are unvaccinated to catch up 
on vaccinations as soon as they are able to, to help them 
understand what vaccines they need, and how they can receive 
them, depending on the applicable laws in the State in which 
they live.
    VaxTeen is also a platform to lobby for change. With 
teenagers nationwide now involved, we work both within our own 
communities and nationally to disseminate accurate information 
and encourage legislatures to enact policies expanding 
adolescents' access to vaccinations.
    Clearly, much has changed since I discovered that initial 
Reddit post. About 1 year later, the World Health Organization 
declared COVID-19 to be a pandemic, and the fears I first 
encountered on Reddit became the fears of my entire generation.
    When would we be able to get vaccinated? What role could we 
play in making that happen? What risks were we posing to those 
around us and that we cared about? Were we safe?
    The time I've spent running VaxTeen has been filled with 
endless questions and searching for answers. Every day I speak 
to young people about what vaccines mean to them, the reasoning 
for why or why not they do or don't want to be vaccinated, and 
how they can protect themselves and their communities and those 
they care about.
    There are certainly obstacles we're facing in convincing 
some young people [inaudible] vaccines have come to feel to 
most of us. They're a way back to normal, allowing us to return 
to school and see our friends. They're a way of protecting our 
families and communities.
    Two years ago, the Senate Committee on Health, Education, 
Labor, and Pensions held a hearing entitled ``Vaccines Save 
Lives: What Is Driving Preventable Disease Outbreaks?'' 
Notably, among those testifying was Ethan Lindenberger, an 18-
year-old whose mother's opposition to vaccinations led him to 
post on Reddit in search of information, catch up on missing 
immunizations without the aid of his parents, and become a 
vocal vaccine advocate.
    The hearing concluded by fleshing out the irony that 
plagues vaccines: Their success in preventing outbreaks of 
disease has led many to forget their effectiveness and impact.
    The pandemic has served as a startling public health 
lesson. Even teenagers who haven't experienced the loss of a 
family member or friend due to COVID-19 have suffered from 
prolonged social isolation and witnessed the economic 
devastation brought on by the disease.
    At this point, it's clear that we each have a 
responsibility to stop the transmission of disease through 
vaccination, social distancing, and other public health 
measures to ensure our collective health. I've witnessed many 
members of my generation take this to heart, volunteering for 
clinical trials [inaudible].
    As we work to bring an end to the pandemic, I hope we'll 
continue to focus on the needs of young people, ensuring the 
safety in the classroom so that in-person learning can 
continue, helping them catch up on routine immunizations that 
were missed due to the pandemic, and expanding their access to 
vaccinations.
    Thank you.
    [The prepared statement of Ms. Danielpour follows:]

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    Ms. DeGette. Thank you so much, Ms. Danielpour, and thank 
you for taking time out of your academic day to be with us.
    Dr. Hoeg, I'm now very pleased to recognize you for 5 
minutes for an opening statement.

           STATEMENT OF TRACY BETH HOEG, M.D., Ph.D.

    Dr. Hoeg. Thank you. I'm so happy to be here.
    My name is Tracy Hoeg, and I'm an American-trained 
physician and had the opportunity to go to Denmark to do an 
epidemiology-related Ph.D. and postdoctoral work. And I'm a mom 
of 10- and 13-year-old boys, and I'm now living back in the 
United States and have had a bit of a unique perspective on the 
school reopening situation and COVID and kids because of my 
continued ties to Denmark and Europe and watching what my own 
children have been experiencing here in the United States.
    And I was struck by the way Europe, and particularly 
Scandinavia, have been very good at prioritizing keeping 
children in school and reducing collateral damage of prolonged 
school closures, and they have, by default, kept their schools 
open as much as possible. And even Denmark has dropped all 
mitigation at this point related to children.
    And I became involved in multiple research studies, 
including published in MMWR, and in particular that study in a 
systematic review found that children are approximately 20 
times more likely to be infected outside of school than inside 
of school.
    And we need to keep that in mind. When we look at our 
mitigation strategies, you know, how much of an impact are they 
having at protecting our kids from the effects of COVID-19, and 
what are the disadvantages to those continued mitigation 
strategies, including quarantines and limited access to school 
and sports of different kinds?
    So when we look at the situation in terms of risks and 
benefits, we need to consider both the risks to children from 
COVID-19 as well as the risks from the secondary effects of the 
mitigation. And we've learned more and more that children have 
a lower risk than we initially thought, with looking at zero 
prevalence data, have a risk of about 1 in 500 to 1 in a 
thousand chance of being hospitalized if infected. And that's 
about a 30 times decreased risk as an 80-or-older-year-old.
    And then in terms of deaths, we've had about 5 to 6 per 
million in children. And for--comparing to 80-year-olds and 
older, that's about a 10,000-fold decreased risk.
    And then we need to also, as others have acknowledged, note 
that this has actually not changed with Delta, the severity, 
though it's become more--though it is more contagious, most 
likely.
    And we also need to remember that unvaccinated children 
have about the same risk of hospitalization as 40- to 50-year-
olds who are fully vaccinated.
    Recent data on long COVID from the U.K. has actually, when 
you look at controls compared to infection--infected children, 
has not found a difference in the rates of symptoms in terms of 
long COVID symptoms, and that's currently most likely the best 
study that we have.
    So while long COVID most likely does exist in some 
children, it's not as big as a problem or not as large of a 
magnitude of a problem as we had originally feared. So that's 
reassuring, not to discount the children who have suffered from 
it.
    And then we need to consider these risks in context of the 
other risks posed to children. And children have--ages 5 to 14 
have a suicide risk that's greater than--dying of suicide is 
greater than 7 times the risk of dying from COVID. And we've 
seen consistent increases in mental health visits.
    And we've also seen, of course, increases in obesity, 
doubling of the rate of obesity, and twice the rate of 
diabetes, per one study, in our children. And all of this while 
we know that schools can open safely, from my own research and 
from Europe even before we had adult vaccination. And we now 
also have access to rapid testing that we should be using at 
all schools to keep kids, as much as possible, in school, in 
sports, and their normal activities.
    So at this point, I would say the burden of proof needs to 
be on our mitigation strategies to make sure that they're 
working and that they're not causing excess damage to the 
health of our children, and this would include quarantines and 
limited access to school and sports.
    We need to make sure that these are having the intended 
effect and look to our own studies and our peer nations in 
Europe for guidance.
    Thank you very much.
    [The prepared statement of Dr. Hoeg follows:]

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    Ms. DeGette. Thank you so much, Dr. Hoeg.
    This concludes the opening statements, and now it's time 
for Members to be able to ask questions to the panel.
    The Chair will recognize herself for 5 minutes.
    And I will agree that the risk--with all of our experts--
the risk to children from COVID-19, from serious long-term 
illness and death, is lower than it is for most of the 
population. But all the parents of young children that I know, 
including several of my staff, that does not give them a lot of 
comfort in their daily lives.
    They want to make sure--and the other thing I'll say is 
most schools in this country are now open. And so the issue for 
us to all determine is what's the best way to keep our kids and 
their families and their communities safe as we reopen the 
schools, which we all agree needs to happen. And, of course, 
that answer is to make sure that every child who's eligible for 
a COVID-19 vaccine can get one.
    As we've learned, though, and I know that all of our 
esteemed experts here and on Webex will say, children are not 
just simply little adults. And one of the reasons we had to 
have the studies and clinical trials for these vaccines is to 
make sure that the vaccine dosage is correct and to make sure 
that the vaccines are safe and effective.
    Pfizer has said it will be submitting a request for 
Emergency Use Authorization for children ages 5 to 11 in early 
October. And then, as has been noted, the FDA may take several 
weeks to assess the data. The data will follow. And we saw some 
interesting news from Johnson & Johnson yesterday.
    So, Dr. Beers, I want to ask you, FDA recently said they 
will work as expeditiously as possible to--to--while still 
following the science when it comes to authorizing a COVID 
vaccine for children. What safety factors will FDA be reviewing 
in this data that's different for children than compared to 
adults?
    Dr. Beers. Yes, absolutely, thank you for that. And I do 
agree that a safe and effective vaccine for 5-to-11-year-olds 
will be a wonderful thing to have.
    And, you know, part of what the FDA is going to look at is, 
of course, the safety data, to make sure that there were no 
additional safety events or unexpected safety events. One of 
the things they'll look at is the effectiveness of the vaccine 
at the dosage that it was given.
    I think what we've heard from Pfizer is that it's likely to 
be about a third of the dose----
    Ms. DeGette. Right.
    Dr. Beers [continuing]. Of the adult dose. So they will be 
looking at a number of those things.
    Ms. DeGette. Now, when Pfizer submits the application and 
when with the FDA does their review, what should the parents 
know about the rigor of this process, and why do you think that 
they should have confidence in the FDA and CDC's 
recommendations?
    Dr. Beers. Well, thank you. I think, in short, it's an 
incredibly rigorous process. It's an incredibly cautious 
process. We do this all the time when we think about vaccine 
development in children. We always start with adults, and then 
we slowly work our way backwards to make sure that anything 
we're recommending for children is safe and effective.
    Ms. DeGette. Thank you.
    Dr. Evans, I want to ask you, obviously protecting our 
children from COVID-19 can't be parents' only focus as we learn 
about these exacerbated mental health struggles. So briefly, 
with the mental health and well-being in mind, what can parents 
and communities be doing right now to support youth and prevent 
crises?
    Please turn your mic on. Thanks.
    Dr. Evans. Yes, sure. Well, I think a number of things. I 
think the first thing that parents need to recognize is that 
one of the biggest predictors of how well the children will do 
is how they do. And around a lot of these issues, it's been a 
lot of anxiety, a lot of, you know, issues with people talking 
about these issues. And so the first thing they have to 
recognize is that they have to take care of themselves.
    I think the other is that children are being affected by 
the pandemic, but not only the pandemic, all of the things that 
are around the pandemic, the financial uncertainty and other 
issues. And that they have to be on the lookout for those kinds 
of signs and symptoms that their children are experiencing 
difficulty and make sure that they're doing everything that 
they can to connect their children to services.
    Ms. DeGette. Thank you.
    Ms. Danielpour, I'm going to ask you, while your peers and 
younger teens are rightly focused on the school day right now, 
if they could hear just one message from you on the importance 
of getting the vaccine, what would it be?
    Ms. Danielpour. Thank you. I think I would say, getting 
vaccinated is really our best tool to getting back to normal, 
getting back to our lives, as well as protecting everyone 
around us. [Inaudible] time has really proved that young people 
care about their communities and protecting their own health 
and those around them. And the vaccine is a great tool for 
doing so.
    Ms. DeGette. Thank you. Thank you so much to all of you.
    The Chair will now recognize the ranking member, Mr. 
Griffith, for 5 minutes.
    Mr. Griffith. Thank you very much, Madam Chair.
    Dr. Hoeg, the public school system in Montgomery County, 
Maryland, requires all students who may have been exposed to a 
student who tests positive to COVID-19 to quarantine for 10 
days. But according to parents, a student who shows symptoms 
similar to those of COVID-19 at their school or in a classroom 
isn't being tested before the school district decides to send 
everyone who may have been exposed to that student home to 
quarantine.
    This policy resulted in nearly 2,000 students being 
quarantined in a week and entire grades of children being out 
of schools. The county recently reversed that policy once they 
rolled out a new rapid COVID-19 testing program.
    Should a testing strategy or program including rapid tests 
be in place at schools to prevent unnecessary quarantining?
    Dr. Hoeg. Yes, thanks for that question. That's a problem 
right now across the country, that children are being sent home 
when they've been exposed and quarantining, resulting in 
unnecessary educational losses and exacerbating the problems 
that we've been discussing. [Inaudible.] There was a very well-
done study out of the U.K. that looked at the test-to-stay 
program, where they tested children who were exposed 5 out of 7 
days of a week, and if they tested negative, you know, each 
morning, they were allowed to stay in school. And they didn't 
find any significant difference in terms of disease spread if 
they were quarantined or if they did that rapid-testing 
protocol.
    And a number of districts across the United States have 
adopted that, and I would highly recommend doing that in 
schools. I would highly recommend that the CDC recommend that 
program to avoid further learning losses and exacerbating the 
secondary effects from the pandemic on children.
    Mr. Griffith. And I think you touched on my next question 
as well, because I was going to go to a new study from The 
Lancet, a medical journal, that found case rates were not 
significantly higher in schools that allowed close contacts of 
infected students or staff members to remain in class with 
daily testing than those that required at-home quarantines.
    Have you looked at that study, and is that the same thing 
you were just trying to say?
    Dr. Hoeg. That is absolutely the same study I was looking--
I was discussing, yes.
    Mr. Griffith. All right. That's what I thought. Sounded 
like it. There went my second question, but I appreciate that.
    You know, what are the impacts of social isolation on our 
children from school closures? What are you seeing? We've heard 
about suicide, but what other impacts are you seeing?
    Dr. Hoeg. Beyond suicide, you know, it's screen time, it's 
increasing amounts of abuse at home, it's poor diet. You know, 
kids, when they're at home, you know, their parents are usually 
working, not inside of the house, and so it's been a concerning 
effect that kids are left to their own devises and not in PE or 
getting the same amount of physical activity, not going out to 
recess. And, absolutely, humans are social creatures----
    Mr. Griffith. Yes, ma'am. Let me focus you in--let me focus 
you in on one of those.
    Dr. Hoeg. Yes, absolutely.
    Mr. Griffith. Do we have any good data yet on the rates of 
abuse and neglect that we've seen during the pandemic? Is it 
up? Do we have any hard data on that? I mean, the supposition 
is it's up.
    Dr. Hoeg. Yes, so the most--the most recent study I saw, it 
actually looked at infants and found that the rates of going to 
the emergency room with abuse was increased. But I actually 
haven't seen a study yet in older children, and I don't know if 
anyone else could speak to that, but that's clearly a concern.
    Mr. Griffith. I see Dr. Beers nodding. That's one of the 
nice things about being in the room together.
    Dr. Beers, do you have some specific data on abuse and 
neglect of children in school age as a result of the pandemic?
    Dr. Beers. Yes. No, I would agree with Dr. Hoeg that we're 
seeing some early data and certainly anecdotally we are 
hearing, but it is a concern. We agree.
    Mr. Griffith. Yes. What--and I go back to Dr. Hoeg. I'm 
just curious. What about remediation for students in the 
school? I mean, what we're seeing, at least in Virginia--I 
think it's probably true across the Nation--is that things 
didn't get taught that were supposed to be taught because they 
didn't have time. I mean, my kids were at varying degrees, 
going 2 days a week, then doing 4 days a week as we got later 
into the year, but still doing a lot of virtual work as well.
    What are we looking about in regard to remediation? I know 
we've gotten a tutor for our kids to try to help get them 
caught back up on what they were supposed to have learned 
during that full year of COVID shutdown or virtual learning.
    Dr. Hoeg. I'm glad that you brought up the fact that you 
got a tutor, because this just points out the fact that, 
because we have no national strategy for accelerated, you know, 
learning this year, that it's the kids who are 
socioeconomically disadvantaged and don't have access to a 
tutor, and with more school closures, that are going to fall 
further behind.
    So it's concerning that we don't have a consolidated 
national strategy for catching kids up, because, as we've seen 
from the data, again, it's the more socioeconomically 
disadvantaged that have fallen the farthest behind.
    Mr. Griffith. Yes, ma'am. So we need some remediation.
    I appreciate it, and I yield back.
    Ms. DeGette. I thank the gentleman.
    The Chair now recognizes the full committee chairman, Mr. 
Pallone, for 5 minutes for questioning.
    Mr. Pallone. Thank you, Chairwoman DeGette.
    It's alarming that, 20 months into the pandemic, COVID-19 
cases among children are at an all-time high as the Delta 
variant continues to surge in communities across the country.
    In fact, Dr. Rush, in your testimony you note that the 
number of hospitalized children due to COVID-19 has tripled at 
children's hospitals. So let me ask you a question: Why are 
hospitals like yours seeing such a dramatic rise in the number 
of pediatric patients with COVID-19?
    I think that the mic is not on.
    Dr. Rush. Thank you so much.
    I think it's multifactorial. Many of the public health 
measures that were in place in 2020 that separated children and 
that kept children more isolated, as we've all talked about 
this morning, also prevented the transmission of disease.
    So children are now back together. They're in school 
settings, many of whom and at least in my community, have not 
had as rigorous restrictions around how to start--restart 
school. And so they are sharing germs again, and we've seen 
that all summer long with other viruses.
    I think the Delta variant is much more contagious. A simple 
analogy is that, with the Alpha variant, the original parent 
strain, one person could infect two to three other people. The 
Delta variant, one person who is infected can infect seven.
    So, if you think about the transmission of the disease, 
it's much broader. Children are unvaccinated, largely. In my 
area, in my region, even the teenage population is 
significantly below the national norms with vaccine 
availability. And so the disease--the Delta variant is just 
spreading more quickly.
    Mr. Pallone. Thank you.
    Let me ask Dr. Beers. Last week, the--this committee 
advanced its portion of the Build Back Better Act, and that 
included a permanent extension of the CHIP program, more than a 
billion for activities to strengthen vaccine confidence, and 40 
million to support children's mental and behavioral health 
needs.
    So I just wanted to ask you, Dr. Beers: Thinking about the 
current state of children's and adolescents' health needs, how 
will those provisions or provisions like that support their 
well-being?
    Dr. Beers. Well, thank you very much for that.
    And the AAP is very much in support of those provisions. I 
think it's just incredibly important for us to be investing in 
the things our children need as we go forward.
    A permanent CHIP extension would be music to every 
pediatrician's ears and something that would allow more 
children to get access to the healthcare that they need.
    In addition, the additional mental health support, as you 
heard from Dr. Evans and all of us, I think, are sorely needed, 
and we need to make sure that we're putting those resources 
where children are and where they're living, schooling, and 
playing. So it would be incredibly valuable.
    Thank you.
    Mr. Pallone. Well, thank you.
    But I also wanted to mention that the Build Back Better Act 
included 250 million for our Children's Hospital GME, graduate 
medical education. So let me go back to you, Dr. Rush. Do you 
and the Children's Hospital Association support that level of 
increase for Children's Hospital GME, and do you believe it 
would help address workforce shortages in pediatric and 
subspecialty care areas?
    Dr. Rush. One hundred percent. Most children's hospitals 
are affiliated with academic medical centers and actually are 
the core of pediatric graduate medical education as well as 
research. And so this funding would ensure that all of those 
training programs, not only for the general pediatrician in the 
community, but also for all the pediatric subspecialists, who 
largely work in children's hospitals, going forward.
    Mr. Pallone. Well, thank you.
    Let me just--one final question for Ms. Danielpour. And I 
know you don't speak on behalf of all young people, but I think 
we can benefit from your insight.
    What single action do you believe young people want to see 
from adults that would help instill confidence that we still 
care about them?
    You know, people always say, well, Congress doesn't really 
care about young people as much as seniors because they don't 
vote, right? But, I mean, is there something that we could do 
that would--or that you believe adults could do to help instill 
the confidence that we do care? I know it seems strange, but, 
you know, I hear that.
    Ms. Danielpour. That's an incredible question to ask.
    While I obviously don't speak for an entire generation, I 
think making young people part of the conversation, whether 
that is somebody who is hesitant and has questions and what--
who needs to be educated and learn why they should be 
vaccinated, as well as I think peer-to-peer messaging could be 
incredibly impactful, and in families.
    I think adolescence is very much a lesson in learning how 
to navigate your family and cultural and socioeconomic issues 
that we have and what they mean to them. And so I think young 
people are uniquely poised to speak to those around them and to 
educate them.
    And so I think one of the greatest things that our 
representatives can do is really involve young people in this 
conversation, make them feel heard.
    Thank you.
    Mr. Pallone. Thank you.
    Thank you, Madam Chair.
    Ms. DeGette. I thank the gentleman.
    The Chair now recognizes the full committee ranking member, 
Mrs. Rodgers, for 5 minutes for questioning.
    Mrs. Rodgers. Thank you, Madam Chair.
    I too want to thank Kelly for joining us and for her 
advocacy. You know, it really is just breathtaking as I think 
about the impact on our children. And, in my circle of friends, 
I have one friend who--he told me over the summer that they 
can't get their daughter out of her bedroom. Another friend has 
had her 14-year-old daughter in the emergency room multiple 
times over the last year for cutting herself, and she's told 
her mom that all she thinks about is killing herself.
    I have another friend who just last week shared with me a 
list her son has texted her. She forwarded this text to me from 
her son who had listed--I don't know--10 or 11--I was looking 
for it--of his friends who have committed suicide by name and 
their age. It's just breathtaking.
    Without a doubt, this pandemic has taken a toll--taken a 
deep toll on all of us and on our children in particular. And, 
as a parent and for many parents, they are understandably 
scared for their children's health and their well-being. The 
24-hour news environment right now, you cannot escape the fear 
and the hysteria. The risk of COVID-19 must be taken seriously, 
but I believe we must have an honest conversation about all of 
the risks that are facing our kids right now--the crisis that 
our kids are in the middle of.
    So, Dr. Hoeg, I wanted to ask: What is the risk of COVID-
19--what risk COVID-19 poses to children, and how does that 
risk compare across age groups and compare to adults?
    Dr. Hoeg. Yes. Thanks for bringing up those very important 
points about mental health.
    And so the risk for children, as I was discussing, for 
hospitalization is, you know, at 20 to 30 times lower than 
older adults. And we're talking, you know, a thousandfold 
difference in terms of risks of mortality. And then--and so the 
risks that--as I discussed earlier, you know, are about--are 1 
in 500 to 1 in a thousand for hospitalization, and we've seen 5 
to 6 deaths per million among children.
    And then could you repeat the second part of your question 
for me, please?
    Mrs. Rodgers. I'm actually going to move on, because my 
concern is that we're taking this very narrow focus. We're 
focusing on COVID-19 while ignoring other health factors.
    Dr. Hoeg. Yes.
    Mrs. Rodgers. Other mental health, social, emotional 
development impacts of the policies that right now CDC and 
other public health agencies across the country are enforcing.
    So, Dr. Hoeg, would you just speak to, you know, when we're 
implementing these mitigation policies for COVID-19, why it's 
important for us to also consider the other health factors and 
that impact on our children--mental health, social, and 
emotional development.
    Dr. Hoeg. Yes. Absolutely. I mean, looking at--we need to 
look at a holistic view of children's health and not just look 
at one disease, because, as I was discussing, you know, suicide 
poses a 7 times increased risk of death than COVID does in 
children in the 5 to 14 age group.
    And, you know, it's kind of ironic that, you know, while 
we're trying to keep these kids 100 percent safe, you know, 
that they're feeling abandoned and they're seeing these 
increased problems of mental health and suicide.
    And so, you know, I think that's also something that has--
where the United States has differed from Scandinavia and from 
Europe, because they've been acknowledging, you know, that 
other threats to children's health are, in many cases, you 
know, more important and of greater magnitude than COVID is.
    And so we need to make sure that, while we're protecting 
kids from COVID, that we're not increasing the risk of these 
mental health problems of--and obviously obesity and diabetes, 
they're not things that are necessarily going to, you know, 
kill children or immediately, but they're lifetime health 
problems that we need to be concerned about.
    Same with mental health, so----
    Mrs. Rodgers. Thank you.
    The CDC currently recommends all children ages 2 and up 
wear a mask indoors. That is not what our international 
partners have advised.
    For example, the European CDC recommends masking adults but 
not kids in primary school. UNICEF and the WHO recommend 
against masking kids under the age of 5.
    Dr. Hoeg, why do you--why do you think the U.S. is 
recommending masking kids as young as 2 years old?
    Dr. Hoeg. I mean, that's a good question. I think that's 
because there is a lot of belief that masking young children is 
having a large impact on the transmission of the disease in the 
United States. And I think that Europe has been better at 
acknowledging that we actually don't really have solid data 
showing that masking children has had an impact--masking 
children in schools particularly has had any impact on 
preventing----
    Mrs. Rodgers. Yes. Thank you.
    Dr. Hoeg [continuing]. Widespread disease.
    Mrs. Rodgers. Thank you. My time has expired.
    I might just mention, when the Director Walensky called to 
tell me about this mask recommendation, I asked her for the 
science, and she said, ``I'll get it to you.''
    I yield back.
    Ms. DeGette. I thank the gentle lady.
    The Chair now recognizes Ms. Kuster for 5 minutes.
    Ms. Kuster. Thank you very much, Madam Chair.
    And I want to thank the ranking member of this 
subcommittee, Representative Griffith, for emphasizing 
vaccines. Children would not need to wear masks if more adults 
would vaccinate, and I wish that the ranking member of the full 
committee would focus on that as well.
    Nobody's suggesting that we are not focused on the mental 
health of children and adolescents. Children and adolescents in 
our country were already facing a growing mental health crisis 
before COVID-19, and today they are struggling with adverse 
childhood events, including trauma, racism, bullying, substance 
abuse disorder, and undiagnosed mental health issues.
    So it is true that the pandemic has added to the stress, 
and I would like to join my colleagues on the other side of the 
aisle to put this pandemic behind us by focusing on increasing 
our vaccination rates. My schools in New Hampshire--one school 
announced today an outbreak of COVID-19. We have very high 
rates even though people have done everything they can.
    So I think your effort to diminish the risk rings hollow. 
I'm a parent. I also have 12 great nieces and great nephews. I 
want to do everything I can to keep them safe.
    So we have found that, between April and October of 2020, 
there is a 24 percent increase in the proportion of mental 
health emergency department visits for children aged 5 to 11 
compared to the same period in 2019. Let's put this pandemic 
behind us.
    And, right here in New Hampshire, I've seen firsthand the 
dire need in our rural communities for adolescent mental 
health. I had the opportunity in August to visit Mountain 
Valley Treatment Center in Plainfield, New Hampshire, where 
children come from throughout our State and throughout the 
country to cope with anxiety disorders and get additional 
treatment.
    And COVID-19 has just increased the challenges for the 
young people that I met and their families. Nerves are frayed 
for parents and children alike. And so let's work together in a 
bipartisan way to keep everyone mentally healthy as we stay 
safe from COVID.
    Ms. Danielpour, you have a unique perspective on this 
panel, and I'm wondering if you could give your perspective on 
how the pandemic has impacted you and your peers and what you 
recommend that adults in this country, and particularly right 
here in Congress, do about it?
    Ms. Danielpour. Thank you.
    I think that clearly the pandemic has had a tremendous 
impact on, I mean, everyone, really especially, though, young 
people. I think it has been incredibly difficult.
    But I also think it's been a time of extreme resilience 
that I've seen among my peers. I've had friends who spent their 
days during the--when at home, they would spend their free time 
delivering groceries to the immunocompromised or elderly who 
couldn't go to a supermarket, who created enrichment programs 
to help underserved schools in our area. They--children who--
learning at home, who perhaps had a parent who couldn't speak 
English, or help with homework, wouldn't fall behind. I think, 
just as--no--I'm sorry--Representative Griffith mentioned that 
he did for his kids, and he provided for them.
    Everyone had increased responsibilities in their own 
families. I think we all witnessed--let's see--young people 
themselves went through so much. I mean, we're meant to be 
around other people. We learn so much from being in a 
classroom, from learning the experiences of others, from 
socializing.
    We witnessed devastation in our own communities and our--
perhaps our own families, perhaps the loss of loved ones. And 
so I think this has been a tremendously difficult time, I think 
for everyone, but really young people in particular.
    And I ask, I think, that we consider what it means to feel 
safe and healthy. I know Representative Rodgers spoke about 
education and mental health and this idea that young people 
should be in classes.
    But I ask students that are at home--a girl named Megan, 
who contacted me, who--telling me that she had successfully 
convinced her parents to let her be vaccinated using vaccine 
resources. She was working in an ice cream store in Woodbridge, 
Virginia, who had--I believe it's Representative Griffith's 
area. And she was yelled at by customers who refused to wear 
masks, and she felt incredibly unsafe.
    And I think, as we discuss getting back to normal and 
getting back to classrooms, I think there is so much to be said 
for the right to feel healthy and safe and protected that we 
cannot discount--and that the vaccines play a large role in 
mental health and that we shouldn't discuss them as something 
that opposes them or separate issues.
    Ms. Kuster. Well, thank you so much. I appreciate your 
perspective. We could use that wisdom here in Congress.
    And I yield back.
    Ms. DeGette. Mr. Burgess, you're now recognized for 5 
minutes for questioning.
    Mr. Burgess. I thank the Chair.
    And this is a terribly important hearing, and I'm always 
mindful of the fact that, as we've entered into this last 20 
months where we've been dominated by a novel coronavirus, a 
duty to keep some humility about you, because you may be wrong 
in just a few months' time, and you may be demonstrably wrong 
and very publicly wrong. And, unfortunately, we've seen some of 
our leaders in public health fall into that.
    And it's not a criticism of them. It's just a feature of 
the fact that you've got a novel illness that's very, very 
dangerous and where there is a lot of fear, a lot of fear on 
the part of parents and children both.
    So I--I think this hearing is extremely important. I've 
already learned a great deal, and I think any--a great hearing 
is one that will perhaps lead to additional questions in an 
additional hearing. It's called congressional job security. But 
I think we clearly are not through with this.
    And I just echo, too, with what Ranking Member McMorris 
Rodgers said. We need to hear from the heads of our agencies 
more than we are. It cannot take weeks and months to get a 
phone call answered on some of these very, very basic 
questions--questions around masks, questions around the 
development of vaccines for children.
    These are important questions that our constituents are 
asking us. It's not us trying to be difficult to the agency 
head, but these are the questions that we are getting from our 
constituents when we go home, and we are, after all, 
representatives of the areas in the country in which we 
represent.
    But there's two issues that I'd really just like to focus 
on a little bit this morning. Dr. Evans, probably talking to 
you for just a second and then our two pediatricians. You know, 
I was struck the other day driving to my district office and 
Dr. Sanjay Gupta comes on CNN--and I hate to admit that I was 
listening to CNN. It was mostly just to get the talking points 
for the opposition.
    But, still, Dr. Sanjay Gupta said--and I forget the figure 
that he gave, but it was a dramatic figure for the increase in 
suicide in young women and how different it was--I mean, it 
was--it was, like, a lot.
    And then, coupled with the articles that we're reading now 
in The Wall Street Journal, has published several articles on 
social media, and particularly Facebook and Instagram. And, in 
fact, Madam Chair, I took the liberty of printing off one of 
the Wall Street Journal articles, and I'd like unanimous 
consent to add that to the record. But it just strikes me that 
that is----
    Ms. DeGette. If the gentleman will submit it, I'll review 
it.
    Mr. Burgess. Yes. I'll be happy to.
    That is an area where we, as a committee who has--yes, we 
have jurisdiction over public health. We also have jurisdiction 
over tech and tech issues. So it seems--and even Mrs. McMorris 
Rodgers brought it up here in our hearing last March about the 
development of products aimed for a population--this was the 
population we want to--we want to subscribe to our product, but 
it's also products of the age that may be actually being hurt 
by their product.
    So would you care--could you comment on that? Is that 
something that you've encountered as well of the suicide risk 
for teens?
    Dr. Evans. Talking to me? OK.
    Mr. Burgess. Yes, Dr. Evans----
    Dr. Evans. Sure.
    Mr. Burgess [continuing]. For teen girls and the effect of 
some of these--some of the social media platforms might be 
having on them.
    Dr. Evans. Sure. So I think it's important to look at these 
platforms both from the positives and the negatives, OK? When--
many of you have talked about the impact of social isolation on 
children. We know that that has a very negative impact. And, 
actually, social media has been something that children--youth 
have within able to use to overcome that and make the 
connection. So, in that sense, it's positive.
    But, as you point out, there are some negatives. The 
research around this is that it's how children use social media 
that is the biggest challenge. The social comparisons, the 
cyber bullying, those kinds of negative kinds of activities are 
the ones that really drive the negative impact that children 
have.
    So I think our social policy, then, has to look at not only 
the length of time--and, actually, the data around that are not 
very--are equivocal, that it's not--there is not a strong 
correlation between the amount of time and the negative impact. 
It's more about how social media is used.
    So I think our social policy, then, has to look at that.
    Mr. Burgess. No. And it just underscores why--how it's--why 
it's important for our committee to perhaps investigate that.
    And, to our two pediatricians, reading about the vaccines 
in young men and the risk of myocarditis, and, when I first 
talked to the CDC, I thought, oh, you're just dismissing the 
females that complain about chest pain and fatigue, but 
apparently not. Apparently it's a real thing in young men, and 
the myocarditis appears to be self-limited.
    But I don't think, again, we can just ignore it. We have 
to--we have to see it upfront and be honest about it. So would 
either of you care to weigh in on that?
    Dr. Beers. Yes, absolutely. I'm happy to, and then if Dr. 
Rush wants to chime in, yes.
    Yes, absolutely, and I think it's actually one of the 
strengths of our vaccine monitoring system, that we have 
actually been able to identify such a rare potential effect of 
the vaccine. And I think continued transparency about that. I--
we remain confident that the risks of the COVID illness far 
outweigh the risks of the vaccine, and you can get myocarditis.
    I will note I have a 13-year-old son, and he is fully 
vaccinated. So I feel personally confident enough in the data 
that my own son is vaccinated.
    Mr. Burgess. And don't misunderstand me.
    Ms. DeGette. Dr. Rush, do you want to add anything to that?
    Mr. Burgess. I have been fully vaccinated myself, and I----
    Dr. Beers. I know.
    Mr. Burgess [continuing]. Think that is----
    Dr. Beers. I know.
    Mr. Burgess. It's important for that message to go out as 
well.
    Ms. DeGette. The gentleman's time has expired, but I will 
allow Dr. Rush to answer the question.
    Dr. Rush. Thank you, Chairwoman DeGette.
    I would agree with Dr. Beers. I think that the rigor with 
which vaccine and all immunizations are studied in children is 
rigorous and ongoing. I think we are learning about the risks 
of myocarditis and pericarditis following vaccination.
    I think, if you adjudicate some of the data that exists in 
the passive surveillance databases, such as VAERS, you will 
actually see that--that some of those cases are not as 
prevalent and that, actually, in preliminary studies that I 
heard about actually yesterday in grand rounds before I got on 
my plane, it shows that the risk of myocarditis right now is 
actually lower than the natural risk in the same age group.
    So I think it will be followed. I think it will absolutely 
be studied by pediatric scientists, and I think there will be 
intense multidisciplinary groups that come together to follow 
this long-term and will advise us--to your point, we will learn 
as we go and make adjustments along the way.
    Mr. Burgess. Sure. Well, as somebody----
    Ms. DeGette. Thank you so much, Dr. Rush.
    Mr. Burgess. Thank you.
    Ms. DeGette. The Chair now recognizes Miss Rice for 5 
minutes.
    Miss Rice. Thank you, Madam Chair.
    And I want to thank all the witnesses for coming today, and 
I'd like to start with you, Ms. Danielpour. You are such an 
impressive young woman. You've achieved so much in just your 
short time on this planet, and you really represent your 
generation so well.
    You mentioned in your opening statement that you--after 
having a conversation with a friend of yours, you kind of went 
down the rabbit hole of trying to find information about 
certain things having to do with this--with COVID and vaccines, 
et cetera.
    And, because you are in the generation who has not--doesn't 
know life without cell phones and computers and tablets, unlike 
me, who grew up with none of that, I just--I'm curious about 
where you got your information, because, you know, we've had 
hearings, especially with this subcommittee, on the incredible 
increase in mis- and disinformation that is available on every 
single social media platform that I'm sure you spend and your 
generation spend time on.
    So how is it that you were able to kind of parse through 
the information that you were finding on social media, to the 
extent that you were there, and find accurate information that 
informed you and this kind of--your VaxTeen's effort that you 
started?
    Ms. Danielpour. Thank you so much.
    Yes. So I initially came across a post on social media that 
inspired VaxTeen, and it very much--the idea of the post is 
that this young person couldn't find information to help them, 
that they were asking this question, hoping for answers.
    I think--I'm not sure how much time everyone here has spent 
perhaps on the CDC site, but I do think there is obviously a 
wealth of trustworthy sources out there, but they can be very 
incredibly hard to navigate, especially if you're someone who 
has--doesn't have a medical degree or know legal terminology.
    And VaxTeen started--I spent an entire year reading 
resources comprised of CDC information and other trustworthy 
sources and distilling them and putting them for young people, 
understanding what they wanted to know and what language should 
be used that they would understand, and putting them in one 
place.
    And so I think there is something unique about the fact 
that my generation has grown up with obviously a wealth of 
information at our fingertips. And with social media I think 
we've uniquely developed tools in that sense to question 
information we see online, to hold it to a higher standard.
    I know many young people who started political fact-
checking organizations and do work to hold representatives 
accountable to that sense. And I think there is very much that 
is--it very much has been ingrained in us. I--in school, I had 
classes about checking the accuracy of sources and what was--
what could I verify, and what should I trust?
    And so I think, in that sense--and people are uniquely 
poised to be messengers and people we can reach. I do believe 
there is very much a need for greater education, for greater 
messaging, but especially that recognizes personal stories. I 
think not just hearing that the organization Dr. Beers 
represents agrees that we should be vaccinated, but also the 
fact that Dr. Beers said she vaccinated her own son. I think 
stories like that are incredibly impactful.
    And I think we should recognize that everyone has their 
unique experiences as well and have a whole network of people 
they can reach. And so I think there is very much a need for 
accurate information that we can trust but that also reach 
people where they are.
    So, if that's on social media, in classrooms, educational 
settings, in club fairs at schools, I do believe young people 
have the tools they need to be the greatest messengers we can 
possibly have, and I think it's something that's underutilized 
at this moment.
    Miss Rice. Well, you're an incredible role model, so thank 
you so much for being so engaged.
    Dr. Evans, you were talking about the impact of social 
media on the mental well-being--mental and emotional well-being 
of our children. I can't think of anything more destructive to 
the development of our young people and their mental and 
emotional well-being, and all you need to know is that the 
people who started all these social media platforms, they don't 
allow their children to have these tablets and to spend time on 
all of these social media websites that can be so destructive.
    So what is--what can we do as legislators to rein in the 
impact--and a lot of this has to do with parenting and how much 
parents allow their children to spend on, you know, how much 
time they allow their children to spend on their devices. But 
what can we do to try to rein in this toxic environment that 
we're allowing our children to grow up on?
    Dr. Evans. Well, I think one of the things is that we have 
to have better research. We heard about the research that 
Facebook did, didn't share it publicly. Now it's been exposed, 
but I think we have to, first of all, use science-based 
strategies to understand the impact.
    What we do know is, as I mentioned, that how children use 
social media does have an impact on their overall mental health 
and well-being.
    From a policy standpoint, I think we have to use that 
information to set--to set limits. I think parents have to set 
limits, particularly for young children, that the APA has come 
out against Instagram's proposal to have a special platform for 
younger children because the data just don't support that.
    And so I think we have to use all of that information to 
form public policy, and especially those areas where we know 
children are using social media in a way that's negative.
    Ms. DeGette. Thank you. I thank the gentleman.
    The Chair now recognizes Mr. McKinley for 5 minutes.
    Mr. McKinley. Thank you, Madam Chairman, and thank you for 
holding this. I think this is an important topic.
    But, as much as I'd like to talk about children and COVID, 
I think we need to discuss the elephant in the room. Why are 
people hesitant to get vaccinated? In my opinion, I think 
they've--one, they've lost confidence in the Government and the 
CDC and the FDA. And that wasn't helped by now Vice President 
Kamala Harris when she stated that she wouldn't get a 
vaccination developed under President Trump.
    And, secondly, the misinformation is rampant on social 
media, undermining people's trust in medicine and the vaccine.
    So, instead of rebuilding confidence and dispelling 
misinformation, the administration has taken--he's--they're 
acting like bullies by requiring all Federal employees and 
contractors that have over 100 employees to have all their 
workers vaccinated by November 22nd.
    Businesses are concerned about this. There is no guidance 
on this mandate. If employers are expected to comply by 
November 22nd, employees will need to do some serious soul 
searching to determine how and if they're going to comply by 
November 1st to get that first shot.
    So businesses in my district this past week or so, we've 
been overwhelmed with questions. One--and so I can direct it 
maybe to you, Madam Chair. Maybe we can get some answers. Will 
there be religious and medical exemptions, and when will they 
be clarified prior to November 1st?
    Who will provide the immunity for employers who have to 
fire their employees who are unwilling to get a shot? 
Vaccinations were likely not part of their employment contract 
when they hired on, so who is going to provide them immunity?
    What about workers who--employees who work remotely? Will 
they be required to get vaccinated?
    What about workers covered under the Older Americans Act? 
Will employers be provided immunity if they have to fire these 
aged employees?
    Again, currently, there is only one--Pfizer is the only one 
that's been fully approved for use by the FDA, so are we going 
to rely on a single source across America for this vaccination? 
And, if an employer is required to take the vaccine and then--
the employee--and if the employee becomes sick from a side 
effect, will the employer be held legally responsible, or will 
there be immunity for him for having been forced to do this?
    How long will these mandates last? What's the goal? What 
are the metrics? Are we trying to get to 100 percent 
vaccination rate? Because we all know that's not going to 
happen.
    So what about--what about the impact on our nursing and 
staffing levels in our healthcare facilities? They're already 
at a stretching point when we have this requirement.
    What about the effect on--impact on national security when 
our key scientists with top-secret clearance leave the 
workforce and with them is that knowledge, the impact that they 
have because they don't want to comply with that?
    And what about the impact on our children when their 
parents--either mental health, stress, or otherwise--when their 
parents lose their job as a result of this?
    So I return to the fundamentals. So, instead of another Big 
Government mandate, why shouldn't this administration be 
addressing the core problem, reinstilling trust in the 
Government and countering this misinformation that's out there 
about the vaccine?
    Do any of you have comments about any of those questions?
    Seeing none, Madam Chairman, I yield back the balance of my 
time.
    Ms. DeGette. I thank the gentleman.
    The Chair now recognizes Ms. Schakowsky for 5 minutes.
    Ms. Schakowsky. Thank you, Madam Chair.
    I thank all the witnesses today. I particularly want to 
focus my questions with Dr. Beers. But I want to talk about 
mis- and disinformation. You know, it was last--way last March 
that this--a different subcommittee, the Health Subcommittee, 
had a hearing on disinformation, and it was in May that members 
of this committee, including the chairman and the chair of the 
subcommittee, sent a letter--I was on it, too--to Facebook 
talking about the misinformation that is there.
    But you mentioned it in your testimony, Dr. Beers, that 
you--you gave testimony that highlighted the dangers of the--
and the role of COVID misinformation in vaccine hesitation and 
that you and other providers have to spend your time correcting 
false claims about the vaccines, and I just would like your--
you to answer, you know, where are these myths being generated, 
and what do you think they have--why do you think that they 
have gained such traction right now?
    Dr. Beers. Yes. I thank you so much for that.
    And I think it's an incredibly important question. And one 
of the things I'll highlight is that misinformation and 
disinformation around vaccines is not new to the COVID-19 
vaccine. It's actually something pediatricians have been 
dealing with for a very long time and has been a challenge. It 
certainly has significantly increased with the COVID-19 
vaccine.
    And I think that comes from a number of different places. I 
think there are people who intentionally spread this 
information for any variety of reasons. I think, you know, 
that's--that's the way our social media platforms work. You 
know, you see things that are reinforcing to what your--to 
where you want to go.
    I think, you know, the other piece, honestly, is just that 
this has been a scary, uncertain time, and so people look to 
try to find information. It's a lot to wade through. It's part 
of why we really do encourage families to come back to their 
pediatrician to talk this through. But sometimes that 
misinformation has reached such a kind of heightened pitch that 
those conversations can be very difficult.
    Ms. Schakowsky. I wonder if you have particularly seen 
lines of misinformation that have targeted communities of 
color?
    Dr. Beers. Yes. We definitely have. You know, and I think 
it's also important to note that there are other very real and 
valid reasons for vaccine hesitancy across many different 
communities, and I don't want to conflate those things, and 
certainly community of--communities of color have some very 
real reasons to ask questions and distrust the medical system 
at times, you know, but, yes, we've certainly seen targeted 
misinformation at any number of communities, and particularly 
communities of color as well.
    Ms. Schakowsky. I also wanted to talk--since we're talking 
about kids, about pediatricians, it seems, have been 
particularly targeted. You mentioned--I'm quoting now--have 
been, quote, ``harassed, booed, spit upon, and/or threatened,'' 
that they've even had to have some security.
    I wonder, you know, beyond the personal cost of such 
attacks, how has this affected the ability to actually go after 
this misinformation?
    Dr. Beers. Yes. Yes. It's very difficult. And I do, you 
know--I--my role as president of the AAP is to guide the health 
and development of children, but also to the health and 
wellness of pediatricians and support pediatricians. And I 
worry very deeply about this, because it has--it has deeply 
impacted pediatricians. It is very difficult for them. It makes 
their jobs harder.
    It is--many of them are losing staff because people are 
calling the office in--people are calling the office and not 
being very nice when they call the office, so many staff are 
leaving because of that, and that's putting increasing strain 
on the health system.
    So it's really--and I think what saddens me the most is 
that it takes away from the pediatrician's ability to do all 
those things that we do, you know, counsel new mothers and help 
a family with their child's asthma attack or, you know--you 
know, to talk them through a difficult period in their life, 
and it distracts from our ability to provide care to our 
patients and families.
    Ms. Schakowsky. In the seconds I have, let me suggest that 
maybe this subcommittee could have an oversight hearing on 
that, on disinformation.
    And let me just say I have legislation, the Consumer 
Protection--Online Consumer Protection Act, which could hold 
these online purveyors of misinformation accountable for what 
they do.
    And I yield back. Thank you so much.
    Ms. DeGette. I thank the gentle lady.
    Mr. Palmer, you're recognized for 5 minutes.
    Mr. Palmer. I thank the gentle lady for recognizing me.
    I'd like to make a point, and I've heard several of my 
colleagues make this, and we've kind of danced around it, that, 
if you want to--Dr. Beers, you made the comment that you wanted 
to reestablish confidence in science.
    I would suggest to you that, if you want to do that, you 
need to practice science and stop practicing political science. 
And I'm concerned that that's a lot of what's driving this 
debate. I was just looking at an article where the CDC was 
getting interference from the teachers' unions, and it had to 
do with a position from the CDC regarding the reopening of 
schools.
    And, shortly after they put our their statement, they had 
an interaction from the American Teachers Federation, and they 
changed their position. The CDC tightened masking guidelines 
after threats from the teachers union.
    And I could go on. Here is a Washington Post article about 
the ``CDC finds scant spread of coronavirus in schools with 
precautions in place,'' yet we persist in keeping the schools 
closed or--and, for instance, now it looks like we're headed 
toward mandating vaccines for our children as young as 5.
    And that--that concerns me. It concerns a lot of people. I 
think what we're going to see out of this is what we've seen 
already during the pandemic, is a massive increase in the 
number of children being home schooled. And what we've seen 
through the years, again, political science being applied to 
home schooled children to talk about socialization and issues 
like that, when in fact there's no issues with socialization in 
home schooled, but there is with kids in public schools who are 
being required to wear masks.
    There is--we've had a massive increase in the number of 
eating disorders, like a 90 percent increase, a 50 percent 
increase in suicide attempts, emergency room visits because of 
suicide attempts in different places.
    And it's just disheartening, because you people are 
supposed to be the ones who have the greatest insight into 
children's health as pediatricians, yet we persist in getting 
conflicting information from the institutions that we should 
count on to be consistent.
    That's what is really troubling about all this, in addition 
to the impact that it's having on children.
    How would you respond to that?
    Dr. Beers. Well, thank you so much for the question.
    I think, you know, certainly I can largely speak about my 
own organization, the American Academy of Pediatrics, and talk 
about how we have made our recommendations during COVID-19 
pandemic.
    We have issued approximately 30 interim guidance 
statements, which we--for each one, we convene a 
multidisciplinary workgroup of pediatric experts from across 
the country from a wide variety of fields who look at all the 
literature. They review that, they come together, they make 
recommendations, and then we review that literature for----
    Mr. Palmer. I'm not interested in the process.
    Dr. Beers. Uh-huh.
    Mr. Palmer. I'm interested in the outcomes and what comes 
out in official statements.
    And, for instance, talking about the socialization, and we 
know that it's not an issue with home schooled kids, but what's 
going on with the public school kids--and it's largely driven 
by the teachers unions--is in conflict with what I think the 
science shows.
    And I think it's going to impact the politics, because the 
NEA membership is declining as more and more parents are 
getting fed up with it. Teachers are getting fed up with it.
    I would like to ask Dr. Hoeg a question, and that is: When 
you look at the antibody levels of young children compared to 
adults--I think the average age of a schoolteacher is 42. How 
would a--the antibody levels of a 5-to-11-year-old be relative 
to a 40-year-old?
    Dr. Hoeg. So I just want to say, first of all, that this is 
not my area of expertise, but having looked at seroprevalence 
data, I have seen that the antibodies that we have been 
measuring have been persisting longer among children after 
they've been infected than among adults.
    So I don't know if that completely answers your question, 
but they do tend to have a more robust antibody and T cell 
response as well to the infection.
    Mr. Palmer. Well, I raise that question because of the 
article that I saw a few months ago--and I know my time, but--
--
    Ms. DeGette. Not to be cutting the gentleman off, but we 
have votes coming up, and I want to try to get to all the 
questioning.
    Mr. Palmer. What time are votes?
    Ms. DeGette. Any minute.
    Mr. Palmer. Oh. I yield.
    Ms. DeGette. So we'd be happy to look at your article if 
you--
    Mr. Palmer. I yield.
    Ms. DeGette [continuing]. Put it in the record.
    I thank the gentleman.
    The Chair now recognizes Mr. Tonko for 5 minutes.
    Mr. Tonko. Well, thank you, Madam Chair, and thank you for 
hosting this important hearing.
    And I have questions that I want to offer the panel. But, 
before I do that, I would remind my colleagues and inform the 
panelists that I've authored a bill that addresses--would 
address through the Academy of Mental Health Institutes the 
mental health impact on frontliners and children of this COVID 
pandemic. And I think it certainly could incorporate the 
effects of social media on the mental health outcome.
    So, with that, I'll continue. Among the best tools we have 
in our fight against the pandemic are safe and effective 
vaccines. Now that adolescents as young as 12 are eligible for 
these vaccines, hopefully with younger children eligible soon, 
they are playing an increasingly critical role in protecting 
millions of children in this country.
    Understandably, parents are sensitive to safety 
considerations when deciding whether to vaccinate their 
children, even for children 12 and older who are eligible for 
the Pfizer vaccine.
    So, Dr. Beers, how safe and effective is this vaccine for 
youth, particularly compared to other routine immunizations, 
such as those against the flu and measles?
    Dr. Beers. Yes. Thank you so much.
    It's an extraordinarily safe and effective vaccine. We 
know, you know, millions of teens have gotten it so far. It's 
safe and effective, and in fact more effective than some of the 
other vaccines that we give. It has a very high efficacy.
    And, again, I'll note both of my teenagers have gotten it.
    Mr. Tonko. Thank you. Thank you for your response.
    And, Dr. Rush, in your testimony, you state--and I quote--
``Tennessee is one of a number of Southern States where there 
is a degree of vaccine unreadiness and misinformation.''
    Now, polling, such as that done by Kaiser Family 
Foundation, indicates that this hesitancy and misinformation 
may be shaping parents' decisions about getting their teens and 
12-year-olds vaccinated against the virus.
    Can you elaborate on that quote that you shared and the 
thinking behind it?
    Dr. Rush. Well, I think that's what we have observed, 
certainly, as we have navigated the pandemic in the State of 
Tennessee and looked at the States around us, particularly as 
we monitored the beginnings of the Delta surge, beginning now 
almost 2 months ago, and as we have navigated the journey.
    I think, as we have looked at our own experience at 
Children's Hospital, we are seeing some robust uptake amongst 
our greater than 12, and those are typically in families who 
themselves have embraced the vaccination. Many of our families 
are--remain hesitant, and our State, as well as some of our 
surrounding States, also lag behind some of the other States in 
the country with respect to the greater than 12 being 
vaccinated.
    We anticipate that that will persist into the younger than 
12----
    Mr. Tonko. Uh-huh.
    Dr. Rush [continuing]. As well, and so, like we have 
shared, the pediatrician and the specialists who care for these 
children and families are the sources of truth. We do believe 
that these vaccines are safe, that the process to bring them to 
approval, even under Emergency Use Authorization, is a very 
rigorous process. Nobody wants to put a child at risk. So we 
believe in the safety of these vaccines for all children when 
they're ready.
    Mr. Tonko. Thank you. And, Dr. Rush, again, what concerns 
have you heard from parents about vaccinating their kids, and 
how do you respond? How should parents be weighing the risks 
and the benefits here?
    Dr. Rush. I think Dr. Beers' comment was very relevant. 
These are safe. They've gone through the same rigorous process 
that all childhood immunizations have gone through, first 
testing in adults, first testing then in an age starting with 
the older children, and then moving to the younger children. 
That is the way all immunizations for children have been 
studied for decades.
    There is rigor in looking at every side effect, tracking 
that side effect, doing the adjudication when surveillance data 
suggests that there may be an uptick in one or more side 
effects, really pulling together the experts that review that 
process under secondary and tertiary processes.
    I think the--we're scientists and pediatricians. We believe 
in the science, and we believe in the process. And I think 
those one-on-one conversations between pediatricians or other 
health specialists are invaluable to walking families, and even 
the teenagers as they make informed decisions, through that 
process.
    And that's how I would respond.
    Mr. Tonko. OK. I'll just conclude by indicating that, while 
we're talking about kids 12 and older who are eligible for the 
vaccine and as we continue now to look at younger than 12, 
ongoing trials are evaluating the dosing, the safety, and the 
efficacy of the vaccine in children under 12, and I would 
believe that FDA will review those data as they are submitted, 
possibly in the next couple of weeks. So there is hope there.
    So, with that, Madam Chair, I will yield back.
    Ms. DeGette. I thank the gentleman.
    Mr. Dunn, you are recognized for 5 minutes.
    Mr. Dunn. Thank you very much, Madam Chair.
    Children have proven to be more resilient to the physical 
effects of COVID-19 than adults, and hospitalization rates for 
infected children are, of course, much lower than for infected 
adults.
    However, many children unknowingly have contracted the 
disease and passed on with little or no symptoms. So, despite 
the data supporting these findings, one of the most contentious 
debates a year and a half later is COVID policies in the school 
room.
    Florida has a great story to tell here when it comes to 
keeping schools open. I believe our children's mental health 
has improved by our State's policies, and so has their parents' 
mental health.
    And, given the low rates of hospitalization, low rates of 
serious disease among children, and that many cases go 
altogether undetected, I believe that we could be learning a 
lot about COVID-19 in children specifically by testing for 
natural immunity--that is, immunity secondary to infection.
    And the most sensitive and specific tests are, of course, T 
cell--T, tango. So--and it's clear from the data that the 
immunity to SARS-CoV-2 is primarily mediated through T cell 
responses, not B. And testing schoolchildren for T cell 
immunity could truly guide science-based decisions about 
masking, social distancing, and vaccination policies.
    I think another piece of the puzzle that's missing is, when 
it comes to kids and COVID, is cost-effective treatment 
options. You know, we appropriated billions of dollars to HHS 
to study and develop therapeutics. There were a number of them 
in the pipeline when we started this. And I'm, frankly, 
frustrated by the lack of treatment options that we have to 
show for that a year and a half later, although we did a great 
job with the vaccine.
    I think all of us share the goal of wanting to protect our 
children from the pandemic. I fear, however, on the contrary, 
we are harming our children by disrupting their formative years 
and natural social development in an effort to control an 
uncontrollable virus by secondary measures of isolation.
    Dr. Hoeg, I'm concerned about vaccine mandates by 
governments on schools and private industry that ignore the 
considerations of natural immunity to COVID-19. How can we use 
that immunity testing to gather better information on how 
COVID-19 impacts kids and how to protect them?
    Dr. Hoeg. Yes. I think that this is a great question, 
because it's something that a lot of parents, a lot of, you 
know, American citizens want to know, is how much protection 
does natural immunity provide?
    And, you know--and I think this is something that we 
haven't gotten as much information on as, for example, in 
Europe, and we're seeing, you know, some data in adults showing 
that natural immunity may actually provide better protection 
than vaccination.
    But we really need to have a--some sort of a message and 
transparency from the CDC about exactly what the expected 
effects of natural immunity are, especially in kids when we're 
looking at, based on the CDC data put out in May, that there 
may be, you know, over 40 percent of kids in the United States 
have been infected.
    And I know, particularly when it comes to the safety signal 
with the myocarditis among boys with the second dose, you know, 
a lot of parents would like to know what is the benefit of 
giving a second dose of the vaccine, especially in the kids who 
have already been infected?
    And so I think these are sort of basic questions that a lot 
of people in the United States would like to know, and we 
haven't really had, you know, messaging about this from the CDC 
now many months later.
    Mr. Dunn. Yes. I think that's low-hanging fruit to get that 
knowledge. I mean, it's a simple test that's available. We all 
know how to interpret it. You know, we have experience with 
that, and it certainly bore out on the SARS-CoV-1 epidemic 20 
years ago.
    Dr. Hoeg, you published an op-ed in which you set the 
record straight on your research findings that were actually 
meant about the school policies as opposed to the CDC's 
policies, which, frankly, misrepresented your findings.
    I commend your research. I commend you for setting the 
record straight.
    Is there a way we can measure the harm done to our kids 
when Federal agencies use the scientific community to push an 
agenda regardless of the facts on the ground?
    Dr. Hoeg. Yes. I mean, then we would have to know what 
the--you know, quantify the harms that were accrued from the 
prolonged school closures, you know, on children because of 
unwillingness to reopen the schools in a timely manner after we 
had the North Carolina study and our study from Wisconsin that 
showed that schools could be safely open.
    And, in our study, we had varying degrees of distance 
between the students----
    Mr. Dunn. Let me ask you one more question before the----
    Dr. Hoeg. Yes, yes.
    Mr. Dunn [continuing]. Time expires. So is it fair to--
again, to Dr. Hoeg: Is it fair to think that you would agree 
that social and mental health risks have been exacerbated by 
the CDC's failure to follow the science and by inconsistent 
messaging?
    Dr. Hoeg. Yes. I do think that, yes.
    Mr. Dunn. Thank you very much for your time. I thank the 
panel.
    Madam Chair, I yield back.
    Ms. DeGette. I thank the gentleman.
    Chair now recognizes Mr. Peters for 5 minutes.
    Mr. Peters. Thank you, Madam Chair.
    I--this may be a hearing that we have gone over a little 
bit, but I am concerned that the pandemic has exacerbated 
disparities in physical and mental health of the--of our 
children as well as their academic and developmental growth.
    And I wanted to ask both Dr. Beers and Dr. Evans--and, Dr. 
Beers, you're not--you're a pediatrician. You're not an 
education expert, but you're a child mental health specialist. 
And, in this capacity and from your experience and leadership 
with the American Academy of Pediatrics, what do we know about 
how the pandemic has affected adolescent development and 
academic achievement and whether this will be long lasting? Dr. 
Beers?
    Dr. Beers. Yep. Yep. Now I've got it. I knew I was going to 
not hit it once.
    Thank you so much for that.
    And, yes, I do--the effects on children over the past 18 
months have been really substantive. It has impacted their 
public health, it's impacted their education, and those impacts 
have not been equitably distributed. I think children who are 
living in low-income families, often children in communities of 
color, who may have been children who have experienced greater 
amounts of grief and loss, are impacted more.
    We're hearing this from our pediatricians across the 
country. I do actually do quite a bit of work in mental health 
systems here in Washington, DC, and access to mental healthcare 
for children. And we are seeing that here, too.
    I think, in terms of recovery, I think we can recover. We 
know that children both thrive with safe, stable, and nurturing 
relationships. We know that, with good supports, they can 
recover. And I think it's incumbent on us now to make sure we 
are putting those supports in place to make sure our children 
get the things they need to address--to address all the 
concerns that have risen here today.
    Mr. Peters. Dr. Evans, I'd ask you to respond to the same 
general question. Has the pandemic affected the development of 
our children from a mental health and behavioral standpoint, 
and whether we know if this is a long-lasting problem?
    Dr. Evans. Yes. Well, we know that the pandemic has had a 
big effect, but, you know, one of the things I want to stress 
is that it's not just the pandemic. We talk about a syndemic, 
because we have the financial, the political, the racial 
justice issues that have been raised, particularly for Asian 
Americans who have been discriminated against, and African 
Americans who experienced the summer last year. So it's a 
number of things that are impacting on children.
    And the one thing that we know, number one, is that 
children are resilient. Children are going to be able to bounce 
back, but we, as adults, have to do and implement policies that 
help that to happen.
    We believe that we have to take a comprehensive public 
health, population health approach. We have to have effective 
and efficient clinical services for children who are 
experiencing significant problems, but we also have to move 
beyond that and start looking at children who are at risk.
    We know who the children in our communities are who are at 
greater risk for having behavioral health challenges. The 
problem with the way we have dealt with behavioral health is 
that we wait until those children have crises before we 
intervene. We have to have more funding and more resources to 
identify those children early on and to intervene in ways to 
reduce the risk, or at least to intervene early.
    And then, finally, we have to make sure that we are doing 
everything we can to build resilience in children, keeping 
children healthy and safe. We know from a lot of psychological 
research what are the factors that are related to psychological 
health. We need to make sure that teachers understand that. We 
need to make sure that parents understand that. We need to make 
sure that we have programs like programs that build resiliency 
in children to do that.
    So--and one other thing that I think is really important. 
We know from studies that look at disasters like 9/11 or 
hurricanes that, for children, the symptoms may last from 1 to 
4 years. But the other thing we have to realize with children 
is that the kinds of harm that is happening really affect the 
trajectory of their lives, and we really need to be thinking 
longer than 4 years in terms of our sustained efforts at 
addressing their needs. And so that means we need to be 
building the infrastructure today.
    I'm very concerned that we are using one-shot temporary 
funding when what we should be doing today is building the 
infrastructure in the workforce and the infrastructure in 
programs that will last over the course of how these children 
will experience these problems over the next several years.
    Mr. Peters. Doctor, let me follow up on that, because what 
I'm interested in is, you say we should direct more funding to 
this issue for early kind of intervention and support. What 
would be the infrastructure that we would fund? Does that exist 
today? Is there existing sort of things we should be funding or 
would we have to create something new for that?
    Dr. Evans. I think it's both. There are existing early 
intervention and prevention programs, but we don't have nearly 
enough of those resources.
    You know, I was a mental health commissioner for many 
years, and in most systems around the country, 95 percent of 
the services dollars that commissioners like myself have are 
directed at treatment. Treatment, by definition, is a reaction 
to something that's already happened.
    If we really want to get ahead of this, we have to have 
more resources for prevention, early intervention. We have to 
get upstream. And one of the big problems with the way we've 
dealt with children's mental health in particular is it is very 
reactive. If you ask the typical parent about getting their 
child----
    Mr. Peters. Doctor, my time is expired. My time is expired. 
I appreciate that very much.
    And, Madam Chair, I yield back.
    Ms. DeGette. I so appreciate that, Dr. Evans. And this 
committee, several years ago, had many, many hearings on 
pediatric mental health, and we welcome your continued 
involvement because we do need to get ahead of it.
    And, Mr. Joyce, you've been very patient. I now recognize 
you for 5 minutes.
    Mr. Joyce. Thank you, Madam Chair, and thank you for 
convening this very important topic today.
    I'm going to ask some very succinct questions for Dr. Hoeg, 
to start. Dr. Hoeg, do you feel that masks and using masks on 
kids in school stops the spread of COVID-19?
    Dr. Hoeg. So I think we need to look at the science that we 
have, and we need to admit that we don't have robust science or 
randomized control trials on this topic, but we have 
observational studies, one from the schools of the COVID 
response dashboard in Florida not finding an impact across mask 
mandates on teachers and students, and then from the CDC in 
Georgia not finding an impact of cloth mask mandates on 
children in terms of disease spread.
    And so we need to recognize that masks may be providing a 
false sense of security or we're not potentially detecting the 
impact that they're having. So that remains an unknown until we 
have better studies.
    We have a randomized clinical trial from Bangladesh now 
that found surgical masking among adults can protect adults 
over 50 years old in the context of also increased distancing. 
But cloth masks in that study did not have any detectible 
impact in terms of SARS-CoV-2 rates in adults.
    Mr. Joyce. Dr. Hoeg, do you feel that isolating and 
quarantining children affects mental health and increases 
mental health issues like anxiety and suicide in children?
    Dr. Hoeg. Yes, I do. I believe that, you know, from what I 
have seen, that we've watched children--a rise in the rates of 
mental health disorders coincide with keeping children in 
remote learning. And so children are, by nature, social 
creatures, and by disrupting this we're taking a major chance 
with their mental health, so----
    Mr. Joyce. And finally, Dr. Hoeg, do you feel that the 
large spike in BMI that we're seeing in children, especially 
kids ages 5 to 11, are we facing future long-term impact in 
pediatric health?
    Dr. Hoeg. Oh, absolutely. So we saw a doubling of the 
increase of BMI among 3-to-11-year-olds. They were the most 
highly impacted in the study released by the CDC, and weight 
during childhood and obesity during childhood has enormous 
impacts on health later--later in life.
    Mr. Joyce. Thank you for those answers.
    I'd like to turn to Dr. Beers. According to data from the 
CDC, early in the COVID-19 pandemic, the total number of 
emergency department visits related to child abuse and neglect 
slightly decreased, but the percentage of such visits resulting 
in hospitalizations increased in comparison to 2019. We've also 
seen reports of increased depression and anxiety in children 
and teens.
    Could you comment on the potential missed and unreported 
cases in these increases in mental health problems among 
children, and do you think that the rise in these issues can be 
attributed to the disruption of children in-person attending of 
school?
    Dr. Beers. Yes. So--yes, thank you. These are absolutely 
things we're concerned about. And I do think that the lack of 
in-person school for many children was a contributing factor. 
It's one of many factors, and I think it's important to 
recognize it is why the AAP very early on in the pandemic in 
our guidance, return-to-school guidance, said that we thought 
it was the highest priority for children to get back to school 
safely and to do that with layered, mitigated precautions so 
that they could.
    Mr. Joyce. And thank you for making that statement clear, 
that the American Academy of Pediatrics advocated for the rapid 
return of kids to school.
    Dr. Beers, you made a statement--and I share your concern--
regarding missed routine vaccines for kids. And I've been 
working with my colleague present here today, Dr. Kim Schrier, 
another pediatrician, in addressing that issue.
    And, finally, in my remaining time, I really want to 
acknowledge, Dr. Beers, that your expertise as a pediatrician 
and as the president of the American Academy of Pediatrics is 
so important. But I also want to acknowledge something that 
some people might not know about you in this room, and that is 
your training at the Portsmouth Naval Hospital and your support 
of the United States military and their children at Gitmo in 
Cuba, at the National Medical Center here in Bethesda.
    I worked at Portsmouth Naval Hospital during Desert Storm 
and Desert Shield, and I saw the hard-working military 
physicians caring for the children and caring for all the 
individuals there. I want to acknowledge that in the few 
minutes that I had remaining.
    Thank you, Madam Chair, and I yield.
    Ms. DeGette. I thank the gentleman.
    The Chair now recognizes Ms. Schrier for 5 minutes.
    Ms. Schrier. Thank you, Madam Chair.
    As the only pediatrician ever elected to Congress, this 
discussion about COVID and children is extremely important to 
me.
    Dr. Beers, thank you for being here today. Thank you to all 
of our witnesses.
    You know, when COVID first hit, data from abroad and here 
in the United States suggested that children were really only 
minimally affected by the disease, and the primary reason for 
closing schools then was their role in transmitting disease to 
others. But with the highly contagious Delta variant, some 
children hospitals' ICUs are now full.
    So, Dr. Beers, some quick questions for you. Do children 
get severe disease from COVID?
    Dr. Beers. Yes, they definitely can.
    Ms. Schrier. And Dr. Rush just told us a heartbreaking 
story about Sophia, who contracted COVID at school, gave it to 
her parents, both of whom tragically perished from the disease.
    Can children spread this disease to others?
    Dr. Beers. Yes, they can. In fact, the CDC estimates that 
almost 120,000 children have lost a primary caregiver to COVID.
    Ms. Schrier. Oh, my goodness.
    Do children get long COVID?
    Dr. Beers. Yes, children can get long COVID. We're still 
learning more about that, but they definitely can get it, and 
it can be very impactful on their lives.
    Ms. Schrier. Can you just list a couple of the primary 
symptoms that they get so people understand how severe long 
COVID potentially is?
    Dr. Beers. Yes, absolutely. They can have cardiac heart 
symptoms, they can have persistent lung systems, neurologic 
symptoms where they, you know, have trouble thinking, and many 
of them have really debilitating fatigue and dizziness where 
they have difficulty standing up and going about their daily 
lives and going to school.
    Ms. Schrier. And we don't even know how long that will 
last.
    So have rates of COVID in children increased with the start 
of the school year?
    Dr. Beers. Yes, we definitely have been seeing more COVID.
    Ms. Schrier. And that difference is different in different 
parts of the country.
    What would you say has distinguished schools where there 
has been lots of transmission from schools where there has not 
been lots of transmission, since masks have been a very 
contentious topic today?
    Dr. Beers. Yes, absolutely. And I think there's really two 
big things. One is the immunization rates in the community and 
the school as a contributing, and the other is the presence of 
the layered mitigated factors that schools implement, so things 
such as masking, distancing, hand washing, you know, testing, 
things like that.
    Ms. Schrier. Thank you. I would also note just for 
clarification, there is a difference between cloth masks, 
KN95s, and surgical masks, in response to some of my 
colleagues. I would also mention that studies done with 
previous iterations of the virus are different from the current 
Delta information.
    So, in your opinion, given a high number of children who 
are asymptomatic and still test positive for COVID, is there a 
role for surveillance testing in schools to keep infectious 
children home when they can spread it to others?
    Dr. Beers. Yes, I do think so. I think, you know, this is 
one of the things we talk about as one of our layered 
precautions in schools, and surveillance testing can be a 
really important part of this sort of overall group of 
precautions to keep children in school safely as much as 
possible.
    Ms. Schrier. Now, just to go down that path, what happens 
when a child in a classroom tests positive?
    Dr. Beers. Oh, gosh. They have to go home, of course. We 
hope that they remain well and don't need to be hospitalized, 
as most children that will be the case. But they do need to be 
home for 10 to 14 days.
    Ms. Schrier. So best-case scenario, they're home for 10 
days, which means their parents are home with them for 10 days, 
10 days of missed work.
    Now, what about all the people next to them, the close 
contacts? I met with a school principal who has the job of 
contact tracing. What happens to all of those kids?
    Dr. Beers. Yes. It varies a little bit, depending on 
whether or not students are wearing masks and whether or not 
they're vaccinated. But they can need to be home for up to 7 to 
14 days if they're unvaccinated and not consistently masking.
    Ms. Schrier. So we could have multiple children home, and 
in middle schoolers and high schoolers, we go to many children 
at home because they're in multiple classes per day.
    So as we're talking about all of these kids potentially 
being home just in case, we talked about test-to-stay policies. 
In fact, that was one of the things that Dr. Hoeg talked about. 
Some schools, including now L.A. schools, have a policy where 
if one person in a classroom is positive, those around that 
person, instead of being asked to stay home for 14 days, 
actually can just be tested--the whole classroom could be 
tested every day and they could stay in, masked and with all 
other safety precautions.
    What do think about that test-to-stay policy and what that 
means for children?
    Dr. Beers. Yes. I think that can be a really effective 
strategy to help make sure children are in school as much as 
possible. Again, it has to be in the context of other important 
strategies, including vaccination and, at least for right now, 
masking. But testing can really help us keep our kids in 
school.
    Ms. Schrier. Last super-quick question. We have heard a lot 
about mental health in kids. If we want our kids' mental health 
to be good, we need to keep them in school. What are the most 
important things we can do to make sure we keep kids in school 
to protect their mental health?
    Dr. Beers. Vaccinate anyone who is eligible and wear masks 
when you are in school.
    Ms. Schrier. Thank you. I yield back.
    Ms. DeGette. I thank the gentle lady. It takes a 
pediatrician to cut to the core. We appreciate it.
    The Chair is now pleased to recognize Mrs. Trahan for 5 
minutes.
    Mrs. Trahan. Thank you, Madam Chair.
    Ms. Danielpour, I, first of all, have to thank you for 
joining us today. I'm so impressed with your composure and your 
poise. Not every college freshman is ready to testify in front 
of Congress, let alone answer our questions, so thank you.
    In your testimony, you mentioned your fear of infecting 
others, and I think a lot of younger Americans feel that same 
way. You know, my daughters, who are much younger than you, 7 
and 11, in fact, they share that fear. You know, can they visit 
Nanny and Papa? Will they get sick as a result of that visit?
    So restrictions, social distancing, wearing a mask, no one 
likes it, but we all have a responsibility to keep our 
families, our communities, and our children safe. So I thank 
you, and I will come back to you.
    I want to first start with Dr. Beers. I don't think it can 
be emphasized enough, especially in this venue, in this 
hearing: Can you just speak to the science supporting children 
wearing masks to slow the spread of COVID?
    Dr. Beers. Yes, absolutely, I'd be happy to. You know, this 
is one of these areas that our expert group reviewed for 
interim guidance. They reviewed hundreds of studies actually 
from a variety of different types of studies and in a variety 
of different settings, and really the science is robust. And we 
are seeing actually this in action in schools, where schools 
who have implemented strong mitigation policies have much lower 
rates of COVID than schools who have not implemented universal 
masking.
    I think some recent examples are a study--saw a couple 
studies in MMWR, from Florida, another from Georgia. There was 
another big group out of North Carolina that saw the same 
thing. So it really is--it's strong, robust evidence.
    Mrs. Trahan. So while, you know, inconvenient: one, 
effective, and, two, it really does cut down on the anxiety I 
see in my own children in terms of their [inaudible] spread to 
others in the community or to their loved ones, their 
grandparents. So I appreciate that.
    It's commendable that in just 9 months, more than 385 
million doses of COVID vaccines have been administered and more 
than 181 million adults and youth as young as 12 years old are 
fully vaccinated in our country. Unfortunately, this still 
represents only 65 percent of eligible Americans nationwide, 
leaving millions of children at risk of serious infection.
    Back in May, news broke of an unvaccinated elementary 
teacher in California who took her mask off to read to students 
and ended up infecting more than half of the classroom. So CDC 
Director Dr. Walensky said that the situation is a prime 
example of how easy it is to undermine efforts to protect 
children too young to be vaccinated.
    Dr. Beers, your testimony stresses that, quote, ``vaccines 
are the key to dramatically decreasing the spread of the virus 
and allowing children to return to a more normal semblance of 
life,'' which is what we all want.
    Why is it important for the health of ineligible children 
that their older peers and adults get the vaccine, and how does 
this help support safe schools as students return to the 
classroom?
    Dr. Beers. Yes, thank you for that. You know, as we've 
discussed right now, children under the age of 12 don't have 
any access to vaccine, and even when, I think, we're hopeful 
that we will have a vaccine for 5-to-11-year-olds, we'll still 
have much younger children who are not yet eligible.
    And so we know children--you know, anyone, you get COVID 
because you're exposed to it, and vaccinated adolescents and 
adults have significantly, significantly lower rates of being 
infected with COVID.
    And so when the adults in a child's life are vaccinated, 
that significantly decreases their exposure to COVID and 
significantly decreases the likelihood that they will get 
infected as well.
    Mrs. Trahan. Great.
    And, Ms. Danielpour, your voice in this conversation is so 
important. We know youth ages 12 to 18 have the lowest 
vaccination rate of any age group. Why do you think the 
vaccination rate is so low among teens?
    Ms. Danielpour. Thank you for your kind words. I think 
there are several issues. Obviously, there are groups that 
falls into two camps. You have the first group which are young 
people who do want to be vaccinated are facing barriers in 
doing so, whether that is that they need a parent present who 
perhaps doesn't have childcare for siblings or cannot get time 
off work while a clinic may be open.
    They have issues to access, as well as I think there are 
also for those who need to be convinced, I think it is 
understandable that people have fears and concerns about 
vaccines, but clearly they are safe and effective.
    I think a lot of it falls into there's--science is an 
evolving process, and so it's understandable that our messaging 
evolves too. But I do believe that there are--there's lots of 
confusion about whether a vaccine is necessary for a young 
person, how effective it is.
    I also think that plays into the process of getting 
vaccinated, concerns about which vaccines work best, how many 
doses, based on [inaudible] and different side effects that 
fall into that, such as puberty, fertility.
    And I do believe [inaudible] increase confidence. I think, 
hopefully, FDA approval will do so. But I do think, speaking to 
the earlier point, there's something to be said at the 
beginning of the pandemic, we were told that young people 
really weren't at great risk of contracting the virus 
[inaudible]. I know everyone around me, those in our community 
were at risk.
    And so I think [inaudible] answered, and I think there's 
very much a need for education, but I do think they recognize 
[inaudible] it's that we're all vaccinated----
    Mrs. Trahan. Thank you so much to Ms. Danielpour. I asked 
you an unfair question to answer with so little time----
    Ms. DeGette. The gentle lady's time is expired.
    Mrs. Trahan. Thank you. I yield back.
    Ms. DeGette. The gentle lady's time has expired, and I 
apologize.
    The Chair will announce that we've come to the fun part of 
the day when there's votes on the floor and we still have more 
Members who wish to ask questions. And our witnesses are doing 
great, so here's what we're going to do.
    Mr. Griffith and I are going to go and vote and come back. 
Mr. Peters has miraculously appeared after voting. And we have 
Mr. O'Halleran, who is a member of this committee. Then we have 
three other Members who have waived on to this committee 
because this is such an important hearing, and we appreciate 
that, and so we will go to them.
    And so, with that, I'm pleased to recognize Mr. O'Halleran 
for 5 minutes, and Mr. Peters will take the chair. Thank you.
    Mr. O'Halleran. Thank you, Madam Chair.
    We have heard quite a bit about COVID-19 vaccines today. 
I'm very hopeful that the FDA will soon issue an Emergency Use 
Authorization to make sure that children under 12 will be able 
to get that much-needed vaccination and protection.
    In the meantime, I find it unacceptable that we are not 
doing everything to protect children, families, their teachers, 
and other school personnel as we return to in-person 
instruction, which I believe in. That has to be part of the 
process, to bring our children into the school environment.
    Some States, like Arizona, have chosen to take many public 
health schools away from this process. The Governor is using 
federally allocated COVID-19 money, relief funds in fact, to 
further incentivize school districts to do away with public 
health best practices like masking. That would cost the school 
for each student $1,800 per student, taking money actually away 
from the students' education. They're forcing school districts 
to choose between much-needed school funding and the safety of 
children, teachers, and families.
    I want to get to my questions here.
    Dr. Beers, I had one question here, but what I'd like to 
ask you is, your vision for not now, not the rest of this year, 
maybe hopefully we get over this pandemic. What do you see that 
this committee continually has to do to be able to make sure 
that we know enough in the future to be able to make rational 
decisions that are hopefully in collaboration with our fellow 
Members?
    Dr. Beers. Well, thank you so much for that question. 
That's a wonderful question to answer, actually. I think, first 
and foremost, really always putting children at the center and 
making sure that children are our priority when we are making 
decisions. I think there's so many important reasons for that, 
and we're seeing, unfortunately, some of the problems that 
happen--that have arisen when that doesn't happen.
    I think we do need to invest in evaluation and research, to 
make sure that we understand how to help children best, and I 
think investing in, as Dr. Evans said, investing in things for 
the long term, understanding that these things impact a 
children's lifetime, and they do need these services and 
supports for a lifetime--or for their childhood. And so really 
making sure that we're investing in long-term solutions and not 
just very short, short things.
    Mr. O'Halleran. And these investments, would you say that 
they are critical to make sure that we will be able to be in a 
position to have the studies necessary to make better decisions 
if this occurs again or when it occurs again?
    Dr. Beers. Yes, most definitely. This will help us, you 
know, have the supports and information that we need. I think 
it's also important, as Dr. Rush and others have noted, to 
support our children's hospitals, our pediatric healthcare 
delivery systems, our pediatricians, all of those who are doing 
this important work so that we can continue to respond and take 
care of children.
    Mr. O'Halleran. And my last question to you, Doctor, by the 
way, is--because my other questions to others have been asked 
already--but beyond these basic measures that we've been 
discussing all day, have you seen any other creative strategies 
for helping to protect kids in school, and what else should 
schools be considering today?
    Dr. Beers. Yes. I have actually seen some really wonderful 
and creative things, and I think, in my mind, this is one of 
the sad things about these really contentious debates we get 
into about some of the basic precautions, is that, as I said 
before, it distracts from really being able to dive in and do 
these important, innovative things for our kids.
    You know, there's outdoor schooling and there's, you know, 
band practice outside, and there's all sorts of, you know, 
really neat things that schools are doing, partnering with 
community-based agencies, you know, looking to, you know, like 
Ms. Danielpour said, looking to our teens and our youth for 
ideas. There's just millions of things we can be doing, and 
that's where I really hope we can focus our energies.
    Mr. O'Halleran. Thank you, Doctor.
    Thank you to the panel. And I just start to get to the 
point where we can work together as a body and protect the 
public safety of our citizens out there. Thank you very much.
    I yield.
    Mr. Peters [presiding]. We have now next in line Mr. 
Carter. Is Mr. Carter back? We have Mr. Carter.
    The Chair now recognizes--take your time and get yourself 
settled--Mr. Carter for the purpose of asking questions for 5 
minutes.
    Mr. Carter. Thank you, Mr. Chairman, and thank all of you 
for being here.
    Dr. Beers, I want to start with you, if I may. The American 
Academy of Pediatrics' COVID-19 recommendations from the summer 
of 2020 stated that the risk of school closures was much 
greater than the health risk of the virus for children and that 
the social isolation could result in, and I quote, ``sexual 
abuse, substance use, depression, and suicidal ideation,'' 
unquote.
    You reiterated this in your written testimony, and you 
said, and I quote, ``the benefits of in-person school outweigh 
the risks in almost all circumstances,'' unquote.
    In your experience, which is obviously extensive, in your 
experience, why did so many school districts ignore the 
recommendations from the American Academy of Pediatrics and 
others to fully reopen during the 2020-2021 school year?
    Dr. Beers. Well, thank you for that. Boy, I wish I knew the 
answer to that question in a lot of ways. I do want to 
emphasize, there's actually two aspects to that guidance, 
right? It is that it is incredibly important to open schools 
and do everything we can, and to do so in a way that keeps our 
students and our staff safe.
    And I think actually what we saw is both ends of that 
spectrum where, you know, we had some schools reopening without 
those precautions, we had some schools not reopening. I think, 
you know, as to why, gosh, you know, there was a lot of fear, 
there was a lot of uncertainty. You know, I wish that we had 
been able to come together more and really rally around being 
able to open schools safely and do the right thing for our 
kids.
    I think we can learn from looking back, but looking 
forward, I think we need to look forward and make sure we're 
continuing to do the right thing for our kids.
    Mr. Carter. OK. Fair enough. As you know, Dr. Beers, a 
Freedom of Information Act request obtained emails between the 
CDC and the teachers union and some officials that revealed 
that the CDC had worked with the American Federation of 
Teachers on their school reopening guidance that was released 
in February of 2020.
    At a time when every teacher in the country was eligible 
for the vaccination, in at least two instances that we're aware 
of, the union's suggestions were incorporated into the 
guidance.
    Did the CDC consult with the Academy of American Pediatrics 
before the guidance was released?
    Dr. Beers. Yes. You know, we have a very nice relationship 
with the CDC, actually, and talk very regularly, and I think we 
learn from their experts, they learn from ours. We do have good 
communication and collaboration. I don't know that I can speak 
to those emails, though.
    Mr. Carter. That's fine. I'm sure you do have a good 
relationship, but that wasn't the question. The question was, 
did the CDC consult with the Academy of American Pediatrics 
before the guidance was released?
    Dr. Beers. Yes. I think, you know, we talk with them on a 
really regular basis and share information on a really regular 
basis. So I think, you know, weekly we're talking to each other 
and sharing information, so I would--you know, I think we take 
each other's expertise into account all the time.
    Mr. Carter. OK. Is that a yes or a no?
    Dr. Beers. I think I can only assume that they took our 
expertise into account because we talk so regularly, but----
    Mr. Carter. And on the other hand, I would assume that they 
didn't because they didn't follow it.
    OK. Dr. Hoeg and Dr. Beers--I'm not going to leave you 
alone yet--do you think that there was any scientific reason--
any scientific reason--that children shouldn't have been in the 
classroom last semester?
    Dr. Hoeg. All right. I don't think that there was, on a 
broad scale, scientific reason that we should have been keeping 
children out of school longer based on the results of our study 
and MMWR and the results of the North Carolina-Duke study.
    Yes, there was flip-flopping at that time from the 
messaging that we were getting that, you know, Dr. Fauci was 
saying we really need to get kids back in school, schools are 
safe based on these studies. And then the CDC sort of walked 
back on that. And, you know, I actually wasn't involved in the 
emails with the teachers' unions, but it was a bit--from my 
observation, it was a confusing point as to why they changed 
their recommendations.
    Mr. Carter. OK. Doctor, while I have you, I want to move 
very quickly because I have little time left. But are you aware 
of any studies on the impact of wearing a mask that has on--on 
the impact that wearing a mask has on children, particularly 
those in kindergarten through fifth grade?
    Dr. Hoeg. In terms of preventing COVID or in terms of other 
impacts?
    Mr. Carter. Other impacts. And preventing COVID. Both.
    Dr. Hoeg. So, again, in terms of preventing COVID, we 
really only have observational and not randomized studies with 
children, and we have not found the masking mandate of children 
have an impact on COVID.
    And then in terms of the negative impacts of masking, we 
need better studies on that. But, again, Europe has--
Scandinavia has not masked under the age of 12 because they 
need proof that it works. And we've taken the opposite approach 
saying, you know, the precautionary that we will mask them 
until we find evidence that we don't need it, so----
    Mr. Carter. But you do agree that there are some other side 
effects that could happen because of mask mandates on children?
    Mr. Peters. The gentleman's time is expired.
    You want to answer that question?
    Dr. Hoeg. Yes.
    Mr. Carter. Thank you.
    Mr. Peters. Very quickly.
    Dr. Hoeg. So, obviously, there's a reason we don't all wear 
masks all day every day. So one can--you know, there's the 
benefit of seeing people smile and being comfortable without a 
mask on. I mean, those I think are pretty obvious.
    In terms of serious side effects, I think we need more--we 
would need more research before we said yes or no.
    Mr. Carter. OK. Thank you, Dr. Hoeg, Dr. Beers.
    Mr. Peters. Thank you very much.
    Mr. Carter. And thank you, Mr. Chairman, for your 
indulgence.
    Mr. Peters. Thank you very much.
    We now recognize--the Chair now recognizes Mr. McNerney for 
the purpose of asking questions for 5 minutes.
    Mr. McNerney. Well, I thank the Chair. And I thank the 
panel for this discussion this morning.
    Dr. Beers, we heard this morning that children are 20 times 
more likely to get infected outside of school than in school. 
Is this a widely accepted statistic?
    Dr. Beers. Yes. I mean, I think that was one study, but, 
yes, I do believe that--or I do think and I agree that children 
are more likely to get infected with COVID in community-based 
settings.
    Mr. McNerney. All right. Thank you.
    Throughout this pandemic, we've championed healthcare 
providers on front lines. As we entered a new phase of the 
pandemic and face another surge due to the Delta variant, it 
has become even clearer that those who care for our children 
play a crucial role in this fight.
    Dr. Rush, as president of the children's hospital in 
Tennessee, you have an important, on-the-ground view of how 
this latest surge is affecting children, caregivers, and 
healthcare providers. Your testimony notes that in recent weeks 
the number of children hospitalized for COVID-19 has tripled in 
Children's Hospital.
    Can you give us a sense of what children's hospitals like 
yours across the country are experiencing now that we have a 
sudden increase in demand? What are the trends as well as for 
beds and staffing? Thank you.
    Dr. Rush. Thank you for that question. So throughout the 
first three surges, most children's hospitals set up COVID 
units, anticipating that we would also have higher numbers of 
hospitalized children within our environment.
    We have sustained a COVID unit dedicated in our hospital 
for children, and I would say for most of the time, we have 
averaged a daily census of two to four patients. That went up 
in the third surge that began in November and really ended in 
January.
    With children, as I think we've talked about a little bit 
today, there are two waves to hospital admissions. The first 
may be with the acute illness. The majority of children, but 
not all that are hospitalized, may have an underlying 
condition: diabetes, obesity, cancer, congenital heart disease. 
But they also, the healthier children, may have a second wave 
where they become ill with a multi-inflammatory syndrome in 
children, and those children absolutely require 
hospitalization. And about 25 percent of them require intensive 
care for a portion of their hospitalization.
    With the onset of the Delta surge, because so many more 
children are simply just becoming infected, we are seeing more 
children. Our peak number prior to August of this year was 15. 
We actually had to open a second unit to hold COVID children. 
We had--our maximum number early September was 27 in our 
children's hospital, and a quarter of those were in intensive 
care, and at least half of those in intensive care were on 
alert for more than just support from a ventilator. They were 
on alert for cardio bypass technology that would support their 
organs that were failing.
    So while it is a small number proportionately, 
proportionately what we know is the rate of hospitalization is 
not really different in the Delta surge. But because so many 
more children are infected, more children are requiring 
hospitalization.
    What has been hard for the healthcare workforce in 
children's hospitals is that we've been running at near 
capacity since spring. As public health measures were eased, 
children began to socialize and viruses that normally infect 
children appeared to infect children offseason. And so we've 
been full all summer with what we in pediatrics traditionally 
think of as winter and fall viruses. So we've layered on top of 
a full capacity the COVID-19 Delta surge.
    Our staff retired. We have run at full capacity now for 6 
months, beyond full capacity at times.
    And as I stated earlier, the third disease that we have is 
our behavioral health disease. I have consistently had equally 
if not more numbers of children admitted to my hospital in the 
last 6 weeks with a behavioral health primary diagnosis as I 
have COVID.
    Mr. McNerney. Thank you. Well, throughout this pandemic, 
we've lauded healthcare workers as heroes, and this is no less 
true today than it was a year ago. Yet the critical workforce 
continues to work under increasingly demanding and stressful 
circumstances.
    Consequently, I'm very pleased that this committee recently 
passed provisions in the Build Back Better Act to invest in 
public health and mental health workers. But it's not clear--
but it is clear that we need to continue to seek ways to invest 
and support the Nation's healthcare workforce.
    Thank you, panel. And thank you, Chair, and I yield back.
    Mr. Peters. Thank you.
    I want to thank the witnesses for your participation in the 
hearing today. I know it takes a lot of work to prepare for 
this. It takes a lot of stamina to sit through it. But your 
testimony before us is invaluable to us as we try to make the 
policy decisions that we make with the best information 
possible.
    So thank you, Dr. Hoeg, Dr. Beers, Dr. Rush, Dr. Evans, and 
Kelly Danielpour for your work on VaxTeen.
    I would like to remind Members that, pursuant to the 
committee rules, we have--you have 10 business days to submit 
additional questions for the record to be answered by witnesses 
who have appeared before the subcommittee. I ask that the 
witnesses agree to respond promptly to any such questions 
should you receive any.
    And Dr. Burgess has asked that we insert in the record, by 
unanimous consent, an article from The Wall Street Journal 
dated September 14, 2021.
    Without objection, that is ordered.
    [The information appears at the conclusion of the hearing.]
    Mr. Peters. With that, the subcommittee is adjourned.
    [Whereupon, at 1:08 p.m., the subcommittee was adjourned.]
    [Material submitted for inclusion in the record follows:]

             Prepared Statement of Hon. Michael C. Burgess

    Thank you, Madame Chair, for holding this important hearing 
today. As of September 9th, 28.9% of COVID-19 cases were 
pediatric cases, and there have been 5.3 million pediatric 
cases since the start of the pandemic according to the American 
Academy of Pediatrics.
    Currently, Texas is amongst the highest in the nation for 
pediatric COVID-19 covid cases. We have hit record breaking 
case numbers at 50,000 in addition to staffing shortages and 
limited ICU beds at numerous Texas facilities. This is no 
longer a virus that only affects adults.
    Despite the increase in pediatric cases, most recently, my 
office is aware of hospitals that have lost up to 100+ 
employees due to the vaccine mandate. This is not unique to 
Texas as healthcare professionals everywhere have been quitting 
their jobs over the past few weeks due to the fear of being 
forced into receiving a vaccine, they do not believe is right 
for them. This is concerning. We need frontline workers now 
more than ever to take care of COVID-19 patients, especially 
children.
    COVID-19 is affecting children everywhere across America. 
However, children are not only being harmed by the virus 
itself, but the long-term effects from lockdowns are also 
presenting serious consequences.
    We have seen an unprecedented increase in behavioral and 
mental health issues in children over the past year. According 
to a study published by the CDC, emergency rooms have seen a 24 
percent increase in mental health-related visits from children 
ages 5 to 11 compared to last year, and an increase of 
emergency visits among older kids at 31 percent.
    While we continue to learn about this virus, it is equally 
important that we address potential solutions to prevent child 
covid cases, hospitalizations, and deaths.
    We know that mandates don't work and often have the 
opposite effect. Educating and encouraging parents to consult 
with their doctor has proven to be an effective way to tackle 
vaccine hesitancy.
    However, there must be additional ways that we can address 
preventative safety measures within schools to reduce the 
number of infections, without jeopardizing in-person learning
    All our districts have been hit hard by this virus. This is 
not a partisan issue. This hearing serves as an opportunity to 
hear from physicians and experts on how we can improve outcomes 
in pediatric COVID-19 cases.
    Thank you all for being here today, and I look forward to 
our discussion.

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